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      ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors

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          Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0,Tyr3]octreotate: toxicity, efficacy, and survival.

          Despite the fact that most gastroenteropancreatic neuroendocrine tumors (GEPNETs) are slow-growing, median overall survival (OS) in patients with liver metastases is 2 to 4 years. In metastatic disease, cytoreductive therapeutic options are limited. A relatively new therapy is peptide receptor radionuclide therapy with the radiolabeled somatostatin analog [(177)Lu-DOTA(0),Tyr(3)]octreotate. Here we report on the toxicity and efficacy of this treatment, performed in over 500 patients. Patients were treated up to a cumulative dose of 750 to 800 mCi (27.8-29.6 GBq), usually in four treatment cycles, with treatment intervals of 6 to 10 weeks. Toxicity analysis was done in 504 patients, and efficacy analysis in 310 patients. Any hematologic toxicity grade 3 or 4 occurred after 3.6% of administrations. Serious adverse events that were likely attributable to the treatment were myelodysplastic syndrome in three patients, and temporary, nonfatal, liver toxicity in two patients. Complete and partial tumor remissions occurred in 2% and 28% of 310 GEPNET patients, respectively. Minor tumor response (decrease in size > 25% and < 50%) occurred in 16%. Median time to progression was 40 months. Median OS from start of treatment was 46 months, median OS from diagnosis was 128 months. Compared with historical controls, there was a survival benefit of 40 to 72 months from diagnosis. Treatment with [(177)Lu-DOTA(0),Tyr(3)]octreotate has few adverse effects. Tumor response rates and progression-free survival compare favorably to the limited number of alternative treatment modalities. Compared with historical controls, there is a benefit in OS from time of diagnosis of several years.
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            ENETS Consensus Guidelines Update for the Management of Distant Metastatic Disease of Intestinal, Pancreatic, Bronchial Neuroendocrine Neoplasms (NEN) and NEN of Unknown Primary Site

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              ENETS Consensus Guidelines for High-Grade Gastroenteropancreatic Neuroendocrine Tumors and Neuroendocrine Carcinomas

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                Author and article information

                Journal
                NEN
                Neuroendocrinology
                10.1159/issn.0028-3835
                Neuroendocrinology
                S. Karger AG
                978-3-318-05841-3
                978-3-318-05842-0
                0028-3835
                1423-0194
                2016
                April 2016
                05 January 2016
                : 103
                : 2
                : 153-171
                Affiliations
                aDepartment of Surgery, San Raffaele Hospital, Università Vita e Salute, Milan, Italy; bDepartment of Endocrine Oncology, University Hospital, Uppsala, Sweden; cDepartment of Pathophysiology, Division of Endocrinology, National University of Athens, Athens, Greece; dDepartment of Surgery, Philipps University, Marburg, Germany; eInstitute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain; fNeuroendocrine Tumour Unit, Royal Free Hospital, London, UK; gDepartment of Endocrinology, Medical University of Silesia, Katowice, Poland; hDepartment of Internal Medicine, Division of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; iInstitute of Anatomic Pathology, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy; jInstitute of Pathology, Technische Universität München, Munich, Germany; kBeatson Oncology Centre, Gartnavel General Hospital, Glasgow, UK; lDepartment of Surgery, CHU Robert Debré, Reims, France; mDigestive Diseases Branch, NIH, Bethesda, Md., USA
                Author notes
                *Prof. Massimo Falconi, Ospedale San Raffaele, Via Olgettina 60, IT-20132 Milan (Italy), E-Mail falconi.massimo@hsr.it
                Author information
                https://orcid.org/0000-0001-9654-7243
                https://orcid.org/0000-0003-2996-4404
                Article
                443171 PMC4849884 Neuroendocrinology 2016;103:153-171
                10.1159/000443171
                PMC4849884
                26742109
                ac8bc0f6-1c5f-4907-96dc-1fc891ca04e7
                © 2016 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 3, Tables: 1, References: 210, Pages: 19
                Categories
                ENETS Consensus Guidelines

                Endocrinology & Diabetes,Neurology,Nutrition & Dietetics,Sexual medicine,Internal medicine,Pharmacology & Pharmaceutical medicine

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