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Jonathan Strosberg



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    P1.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 944)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.12-06 - Pulmonary Neuroendocrine (Carcinoid) Tumors: CommNETs/NANETS Endorsement and Update of the ENETs Best Practice Consensus (ID 13029)

      16:45 - 18:00  |  Author(s): Jonathan Strosberg

      • Abstract

      Background

      The lung is the most common single site of origin of neuroendocrine cancers, and lung neuroendocrine tumor (LNET) incidence and prevalence is rising. There is a lack of both LNET-specific data and up to date clinical guidance. Management of LNETs often relies on extrapolation from other tumor sites. The Commonwealth Neuroendocrine Tumour Collaboration (CommNETS) and North American Neuroendocrine Tumor Society (NANETS) sought to consider current data and provide updated guidance on LNET diagnosis and management.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The latest best practice consensus on LNETs was published by the European Neuroendocrine Tumor Society (ENETS) in 2015. A review of content and methods using the AGREE II Rigour of Development subscale (www.agreetrust.org) confirmed the quality of the ENETS initiative, providing a basis for endorsement and update. A systematic literature search was conducted and a 22 member, multidisciplinary CommNETS/NANETS expert panel endorsed or modified recommendations from a patient-centered perspective. All statements were graded using Oxford criteria (CEBM.net).

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 230 studies were identified for consideration by the panel. Recommendations were modified or added to reflect clinical data not available in 2015. Out of the 52 ENETS statements, 40% were endorsed, 58% were modified or updated, one was removed and four were added. Themes identified in the consensus update include new statements, practice changing modifications, augmented grades of recommendation and statement refinements, each addressing specialties ranging from epidemiology, pathology and diagnosis to treatment and follow-up (Table 1). The importance of LNET directed research and patient-centered care throughout the treatment trajectory is also emphasized, along with directions for future research.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Ongoing collaboration is essential for future development of updated LNET clinical guidance and to direct research efforts in a patient-centered context. Our consensus update demonstrates international collaboration to develop guidance on clinical management of malignancies for which limited data are available.

      Table 1. Themes in CommNETS/NANETS Lung NET Consensus Update

      New statements

      Epidemiology

      Highlights marked increase in the incidence and prevalence of lung NETs

      Radiation Therapy

      Guidance on use of palliative EBRT for patients with symptomatic locally advanced or metastatic disease

      Medical Therapy

      Recommendation of pre-surgical prophylaxis with SSAs for patients with carcinoid syndrome

      Indicates lack of benefit of anti-angiogenics in lung NET

      Practice changing statement modifications

      Diagnosis

      Indicates limited clinical value of chromogranin A in lung NET diagnosis and disease state characterization

      Surgery

      Indicates that cytoreductive surgery of the liver may be expanded to patients with non-aggressive tumors, including those with more limited extra-hepatic disease

      Statements with augmented recommendations

      Surgery

      The grades of recommendation for complete anatomic resection and systematic nodal dissection for peripheral tumors and for preference of lung parenchymal-sparing surgery over pneumonectomy were each augmented to Grade B

      Medical Therapy

      The grades of recommendation for PRRT and mTOR inhibitors statements were augmented to Grades B and A, respectively

      Statement refinements

      Pathology

      Refined to reflect new standards for classification (WHO 2015) and staging (UICC/AJCC 8th edition)

      Tailored to highlight need for endobronchial biopsy or surgical resection for sufficient sampling to differentiate TC from AC

      Diagnosis

      Radiological imaging statements were modified to simplify guidance and clarify differences in requirements for diagnostic compared to liver imaging, and to guide application of various nuclear imaging techniques

      Bronchoscopy statements were simplified to highlight efficacy and safety of bronchoscopy

      Surgery

      Surgery for localized disease statements modified to reflect equivalence of sublobar resection and lobectomy, especially for typical carcinoid tumors

      Endobronchial resection statements were revised to reflect need to limit procedure to high risk patients or as a bridge to surgery

      Medical Therapy

      Follow-up statement was revised to better define and direct post-treatment surveillance for lung NETs patients who receive medical therapy

      AC; atypical carcinoid; EBRT, external beam radiotherapy; NET, neuroendocrine tumor; PRRT, peptide receptor radionuclide therapy; SSA; somatostatin analog; TC, typical carcinoid

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