Madrid, November 10, 2022-. Neuroendocrine tumors start in specialized cells called enterochromaffin cells which have features similar to nerve cells and hormone-producing cells. They are rare tumors, around 3,000 to 4,000 cases a year in this country1 and can appear in any organ in the body. 65% start in the gastrointestinal tract, 25% in the bronchial system, and the remaining 10% in other parts of the body.
As Dr. Enrique Grande, head of the Medical Oncology Service at MD Anderson Cancer Center Madrid and head of Clinical Research at MD Anderson Foundation Spain explains, “these tumors can appear throughout the body, in the esophagus, the stomach, the pancreas, the rectum, the midgut, the lung, the lymph nodes or in the liver, and there are cases in which we cannot find where the primary tumor originated. Above all, they lead to liver metastases, but there are some that only cause bone or lung metastasis, and the ability to produce hormones that induce symptoms happens in only 30% of cases.
In this sense, the multidisciplinary management of neuroendocrine tumors and their treatment in specialized units is key to offering patients the best treatment at each stage of the disease. “They are extremely heterogeneous tumors, which does not make a good diagnosis easy. That is why it is important that, once treatment is decided on, these patients can go to this type of multidisciplinary unit”.
Radiodiagnosis and nuclear medicine are techniques that cover both the image and functionality of the lesions found and are vital when studying and planning tumor treatments. A study recently presented within the framework of the Spanish Society of Medical Oncology (SEOM) congress, in which more than 300 patients from 40 different hospitals in Spain participated, highlights the efficacy of using the radiopharmaceutical lutetium and reinforces the idea of using theragnostics in the approach to certain types of neuroendocrine tumors.
Theragnostics consists of using molecules linked to radioactive isotopes to diagnose and treat a variety diseases. “Just as we use sugar in a normal PET scan, in this case the contrast used is a liquid that emits light, still a radioactive atom, but of very low intensity. If the tumor captures the contrast agent, it will be marked, and that will tell us that this specific tumor would be a candidate to use the drug, which uses the same vehicle as the contrast, but this time adding lutetium with a high level of radioactivity which acts as the therapeutic agent. This is the concept of theragnostics: diagnosis on the one hand and therapy on the other”, explains Enrique Grande.
The efficacy of these radiopharmaceuticals has been demonstrated in well-differentiated neuroendocrine tumors, like those originating in the digestive tract. Although it is true that they are beginning to be used in neuroendocrine tumors in the lung or outside the gastrointestinal tract, as well as in other endocrine tumors that may also express the somatostatin receptor, which is the target of lutetium.
Greater accessibility to diagnostic tests for patients
Greater accessibility of the general population to image testing is what is allowing these tumors to be diagnosed earlier and earlier. But today it is still considered that the average delay in diagnosis of these patients is 5 years. That is why it is important that, once treatment is planned, they have access to this type of multidisciplinary unit.
“In my case, there were no clues (symptoms) that the disease had started and was spreading. When a lymph node adenopathy was detected, the rapid diagnosis route was activated from Primary Care, and I only had to wait two months to have confirmation of my metastatic neuroendocrine tumor following a pathology study. There was a short time with an enormous emotional impact, during which no specialist suspected or even imagined a neuroendocrine tumor, and all the initial tests were aimed at looking for some type of lymphoma, which is more common than neuroendocrine cancer”, explains Blanca Guaras, president of the Association of Patients with Neuroendocrine Tumors, NET-ESPAÑA.
In the opinion of the president of NET-Spain, there are many areas for improvement. Regarding the diagnosis, knowledge must be disseminated at Primary Care services and to specialists in any discipline to be able to detect the disease earlier and reach a diagnosis in the earlier stages, when options of a cure may be real. “In relation to the treatment of these patients, greater investment in research is needed, to encourage patient participation in clinical trials and establish rapid, effective care paths to centralize the experience so that all patients can be treated at centers specialized in neuroendocrine cancer”, says Ms. Guaras.
1 Grupo Español de Tumores Neuroendocrinos y Endocrinos (GETNE),