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1.
Medicina (Kaunas) ; 57(12)2021 Nov 23.
Article in English | MEDLINE | ID: covidwho-1613898

ABSTRACT

Background and Objectives: Long-acting somatostatin analogues (SSA) (octreotide LAR and lanreotide Autogel) are recommended as first line treatment of locally advanced or metastatic well-differentiated neuroendocrine tumors (NETs) with a good expression of somatostatin receptor (SSTR). Both of these SSAs are usually administered via injections repeated every 4 weeks. The purpose of the study was to compare the route of SSA administration (injection performed by professional medical staff and self-administration of the drug) with progression-free survival. Materials and methods: 88 patients in 2019 and 96 patients in 2020 with locally advanced or metastatic well-differentiated NETs were included in the study. All patients had a good expression of SSTR type 2 and had been treated for at least 3 months with a stable dose of long-acting somatostatin analogue every 4 weeks. All of them had received training on drug self-injections from professional NET nurses at the beginning of the COVID-19 epidemic. Results: The rate of NET progression in the study group in 2020 was higher than in 2019 29.1% vs. 18.1% (28 vs. 16 cases), p = 0.081. Conclusions: The method of administration of long-acting SSA injection performed by professional medical staff vs. self-injection of the drug may significantly affect the risk of NET progression. The unequivocal confirmation of such a relationship requires further observation.


Subject(s)
Neuroendocrine Tumors , Octreotide/administration & dosage , Peptides, Cyclic/administration & dosage , Self Administration , Somatostatin/analogs & derivatives , Humans , Neuroendocrine Tumors/drug therapy , Somatostatin/administration & dosage , Treatment Outcome
3.
J Nucl Med Technol ; 49(3): 265-268, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1399104

ABSTRACT

Metaiodobenzylguanidine (MIBG) imaging has been the standard for neuroblastoma staging for many decades. Novel agents such as 18F-DOPA and 68Ga-DOTATATE are being used nowadays in academic centers. During the coronavirus disease 2019 (COVID-19) pandemic, procurement of 123I-MIBG has proved particularly challenging, necessitating the use of 68Ga-DOTATATE PET. 68Ga-DOTATATE is Food and Drug Administration-approved for imaging of somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors. Methods: 68Ga-DOTATATE PET/CT imaging was performed for staging of 3 pediatric patients with neuroblastoma at our institution. A review of the literature was also completed. Results: 68Ga-DOTATATE PET/CT scans were successfully performed on all patients. All patients showed 68Ga-DOTATATE-avid disease. PET scans showed an excellent spatial resolution and demonstrated high accuracy in concordance with current European Association of Nuclear Medicine guidelines. Conclusion: We have presented 68Ga-DOTATATE PET/CT imaging for staging of neuroblastoma and believe it can reliably be used as an alternative to 123I-MIBG. It has technical, clinical, and practical advantages making it an attractive option. Further multicenter studies are required before it can be recommended for standard clinical use.


Subject(s)
COVID-19 , Neuroblastoma , Neuroendocrine Tumors , Organometallic Compounds , Child , Gallium Radioisotopes , Humans , Neuroblastoma/diagnostic imaging , Neuroendocrine Tumors/diagnostic imaging , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , SARS-CoV-2
6.
Oncologist ; 26(7): e1171-e1178, 2021 07.
Article in English | MEDLINE | ID: covidwho-1258098

ABSTRACT

Octreotide acetate (octreotide) is the most prescribed and most studied somatostatin congener, or analog, for gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and carcinoid syndrome, the latter of which may be characterized by debilitating diarrhea and flushing. Approved in the U.S. more than 30 years ago, octreotide is widely used to control the symptoms of carcinoid syndrome and has been shown to demonstrate antiproliferative activity. The two formulations available in the U.S. include a subcutaneous immediate-release (IR) injection introduced in 1989 and a long-acting repeatable (LAR) intramuscular injection approved in 1999. Lanreotide depot (lanreotide), a more recent somatostatin congener, has been available in the U.S. since 2014. Despite widespread use of octreotide LAR, several key challenges exist with the current depot-based treatment paradigm. Studies indicate that LAR formulations are associated with continued unmet patient needs, owing in part to a loss of bioactivity over time that may necessitate progressive supplemental treatment with IR octreotide to adequately control symptoms. Clinicians should understand the key differences in the pharmacokinetic profiles of the LAR and IR formulations that may contribute to bioactivity loss and somatostatin receptor desensitization. In addition, there is a need to re-evaluate the role of IR octreotide in combination with depot therapy to provide consistent bioavailability and better control of carcinoid syndrome symptoms. The purpose of this review is to explore all these issues and to re-establish a rationale for the IR formulation, particularly with respect to novel use cases and its use during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE: There is a need to re-evaluate the role of immediate-release octreotide in combination with depot therapy to provide consistent bioavailability and better control of carcinoid syndrome symptoms.


Subject(s)
COVID-19 , Neuroendocrine Tumors , Humans , Neuroendocrine Tumors/drug therapy , Octreotide/therapeutic use , Pandemics , SARS-CoV-2 , Somatostatin
7.
Endocrine ; 72(2): 340-348, 2021 05.
Article in English | MEDLINE | ID: covidwho-1159631

ABSTRACT

INTRODUCTION: Angiotensin-converting enzyme 2 (ACE2) is the receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The effects of SARS-CoV-2 on normal pituitary glands function or pituitary neuroendocrine tumors (PitNETs) have not yet been elucidated. Thus, the present study aimed to investigate the potential risks of SARS-CoV-2 infection on the impairment of pituitary glands and the development of PitNETs. METHODS: PitNETs tissues were obtained from 114 patients, and normal pituitary gland tissues were obtained from the autopsy. The mRNA levels of ACE2 and angiotensin II receptor type 1 (AGTR1) were examined by quantitative real-time PCR. Immunohistochemical staining was performed for ACE2 in 69 PitNETs and 3 normal pituitary glands. The primary tumor cells and pituitary cell lines (MMQ, GH3 and AtT-20/D16v-F2) were treated with diminazene aceturate (DIZE), an ACE2 agonist, with various dose regimens. The pituitary hormones between 43 patients with SARS-CoV-2 infection were compared with 45 healthy controls. RESULTS: Pituitary glands and the majority of PitNET tissues showed low/negative ACE2 expression at both the mRNA and protein levels, while AGTR1 showed high expression in normal pituitary and corticotroph adenomas. ACE2 agonist increased the secretion of ACTH in AtT-20/D16v-F2 cells through downregulating AGTR1. The level of serum adrenocorticotropic hormone (ACTH) was significantly increased in COVID-19 patients compared to normal controls (p < 0.001), but was dramatically decreased in critical cases compared to non-critical patients (p = 0.003). CONCLUSIONS: This study revealed a potential impact of SARS-CoV-2 infection on corticotroph cells and adenomas.


Subject(s)
COVID-19 , Neuroendocrine Tumors , Humans , Peptidyl-Dipeptidase A/genetics , Pituitary Gland/metabolism , SARS-CoV-2
8.
Endocrine ; 71(1): 14-19, 2021 01.
Article in English | MEDLINE | ID: covidwho-1008085

ABSTRACT

PURPOSE: During the COVID-19 pandemic, there have been particular concerns regarding the related impact on specialist tumour services. Neuroendocrine tumour (NET) services are delivered in a highly specialised setting, typically delivered in a small number of centres that fulfil specific criteria as defined by the European Neuroendocrine Tumour Society (ENETS). We aimed to address the COVID-19-related impact on specialist NET tumour services in England and other countries. METHODS: Electronic survey addressing patient access and delivery of care distributed to all ENETS Centres of Excellence (CoE) in England and matching number of ENETS CoE elsewhere. Semi-quantitative and qualitative analyses of survey responses were performed. RESULTS: Survey response of ENETS CoE in England was 55% (6/11). Responses from six non-UK ENETS CoE elsewhere were received and analysed in a similar manner. Relevant disruption of various NET services was noted across all responding Centres, which included delayed patient appointments and investigations, reduced availability of treatment modalities including delayed surgical treatment and a major negative impact on research activities. The comparison between English and non-UK ENETS CoE suggested that the former had significantly greater concerns related to future research funding (p = 0.014), whilst having less disruption to multidisciplinary meetings (p = 0.01). A trend was also noted towards virtual patient appointments in ENETS CoE in England vs. elsewhere (p = 0.092). CONCLUSIONS: Restoration of highly specialised NET services following COVID-19 and planning for future service delivery and research funding must take account of the severe challenges encountered during the pandemic.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility , Neuroendocrine Tumors/therapy , Pandemics , Belgium/epidemiology , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Delivery of Health Care/statistics & numerical data , England/epidemiology , France/epidemiology , Greece/epidemiology , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Israel/epidemiology , Italy/epidemiology , Netherlands/epidemiology , Neuroendocrine Tumors/epidemiology , SARS-CoV-2 , Surveys and Questionnaires
10.
J Endocrinol Invest ; 44(5): 989-994, 2021 May.
Article in English | MEDLINE | ID: covidwho-716449

ABSTRACT

INTRODUCTION: The organization of the healthcare system has significantly changed after the recent COVID-19 outbreak, with a negative impact on the management of oncological patients. The present survey reports data collected by the Italian Association for Neuroendocrine Tumors on the management of patients with neuroendocrine neoplasia (NEN) during the pandemic dissemination. METHODS: A survey with 57 questions was sent to NEN-dedicated Italian centers regarding the management of patients in the period March 9, 2020, to May 9, 2020 RESULTS: The main modification in the centers' activity consisted of decreases in newly diagnosed NEN patients (- 76.8%), decreases in performed surgical procedures (- 58%), delays to starting peptide receptor radionuclide therapy (45.5%), postponed/canceled follow-up examinations (26%), and canceled multidisciplinary teams' activity (20.8%). A low proportion of centers (< 10%) reported having to withdraw systemic anti-tumor medical treatment due to concerns about the pandemic situation, whereas PRRT was withdrawn from no patients. CONCLUSION: Although the COVID-19 outbreak induced the centers to reduce some important activities in the management of NEN patients, the Italian network was able to provide continuity in care without withdrawing anti-tumor treatment for the majority of patients.


Subject(s)
COVID-19 , Neuroendocrine Tumors/therapy , Pandemics , Adult , Antineoplastic Agents/therapeutic use , Continuity of Patient Care , Female , Humans , Italy/epidemiology , Male , Medical Oncology/statistics & numerical data , Neuroendocrine Tumors/surgery , Patient Care Team/statistics & numerical data , Surveys and Questionnaires
11.
Eur J Endocrinol ; 183(2): G79-G88, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-701828

ABSTRACT

In viral pandemics, most specifically Covid-19, many patients with neuroendocrine neoplasms (NENs), including phaeochromocytomas, paragangliomas and medullary thyroid carcinoma, may develop Covid-19 in a mild or severe form, or be concerned about the influence of viral infection relative to their anti-tumoral therapy. In general, newly presenting patients should be assessed, and patients recently receiving chemotherapy, targeted therapy or radionuclide therapy, or showing tumour growth, should be closely followed. For previously diagnosed patients, who have indolent disease, some delay in routine follow-up or treatment may not be problematic. However, patients developing acute secretory syndromes due to functional neuroendocrine neoplasms (such as of the pancreas, intestine or lung), phaeochromocytomas and paragangliomas, will require prompt treatment. Patients with life-threatening Covid-19-related symptoms should be urgently treated and long-term anti-tumoral treatments may be temporarily delayed. In patients with especially aggressive NENs, a careful judgement should be made regarding the severity of any Covid-19 illness, tumour grade, and the immunosuppressant effects of any planned chemotherapy, immunotherapy (e.g. interferon-alpha), targeted therapy or related treatment. In other cases, especially patients with completely resected NENs, or who are under surveillance for a genetic disorder, a telephone or delayed consultation may be in order, balancing the risk of a delay against that of the possible development of Covid-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Disease Management , Neuroendocrine Tumors/therapy , Pneumonia, Viral/therapy , Telemedicine/trends , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Endocrinology/methods , Endocrinology/trends , Humans , Neoplasm Grading/methods , Neoplasm Grading/trends , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/methods
12.
Endocrine ; 70(1): 6-10, 2020 10.
Article in English | MEDLINE | ID: covidwho-654265

ABSTRACT

Primary neuroendocrine tumors of the thymus are extremely rare. In patients with advanced disease, tumor growth control, and sometimes also syndrome control are the main goals of systemic therapy. Unfortunately, no standard therapies are available in clinical practice; therefore, clinical studies are strongly recommended. Axitinib (AXI) is a tyrosine kinase inhibitor, currently under investigation in an international phase II/III trial including thymic neuroendocrine tumors. Over the past 5 months, the entire world has been facing a devastating medical emergency brought about by a pandemic due to a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in Wuhan, China, in late 2019. Since then, health professionals have been expending all their efforts on trying to provide the best available treatments for patients involved. Patients with cancer, especially those with thoracic involvement, are at higher risk of coronavirus disease 19 (COVID-19) and its complications because of their immunosuppressive status caused by the cancer and the anticancer therapies. As it remains unclear how to optimally manage such patients, we wished to report our experience with a patient with a metastatic neuroendocrine tumor of the thymus infected with SARS-CoV-2 in the hope that it may provide some insights and reflections on the management of cancer patients during this challenging time in our history.


Subject(s)
Betacoronavirus , Carcinoid Tumor/drug therapy , Coronavirus Infections/epidemiology , Neuroendocrine Tumors/drug therapy , Pneumonia, Viral/epidemiology , Thymus Neoplasms/drug therapy , Aged , Axitinib/adverse effects , Axitinib/therapeutic use , Azithromycin/therapeutic use , COVID-19 , Carcinoid Tumor/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Humans , Hydroxychloroquine/therapeutic use , Italy/epidemiology , Male , Neuroendocrine Tumors/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Protein-Tyrosine Kinases/antagonists & inhibitors , Randomized Controlled Trials as Topic , SARS-CoV-2 , Thymus Neoplasms/epidemiology , Tomography, X-Ray Computed , Treatment Outcome
16.
Surg Oncol ; 34: 182-185, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-133568

ABSTRACT

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, governmental agencies, state medical boards, and healthcare organizations have called for restricting "elective" operations to mitigate the risk of transmission of the virus amongst patients and healthcare providers and to preserve essential resources for potential regional surges of COVID patients. While the fear of delaying surgical care for many of our patients is deeply challenging for us as cancer care providers, we must balance our personal commitment to providing timely and appropriate oncologic care to our cancer patients with our societal responsibility to protect our patients (including those on whom we are operating), co-workers, trainees, families, and community, from undue risks of contracting and propagating COVID-19. Herein, we present guidelines for surgical decision-making and case prioritization developed among all adult disease specialties in the MD Anderson Cancer Center Departments of Surgical Oncology and Breast Surgical Oncology in Houston, Texas.


Subject(s)
Clinical Decision-Making , Coronavirus Infections/epidemiology , Neoplasms/surgery , Patient Selection , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Betacoronavirus , Breast Neoplasms/surgery , COVID-19 , Digestive System Neoplasms/surgery , Endocrine Gland Neoplasms/surgery , Humans , Melanoma/surgery , Neuroendocrine Tumors/surgery , Pandemics , Patient Care Team , Peritoneal Neoplasms/surgery , SARS-CoV-2 , Sarcoma/surgery , Surgical Oncology
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