Treatment

Conditions treated:

  • Pancreatic NETs
  • Well-differentiated tumors of the GI tract (stomach, small intestine, appendix, colon and rectum), kidney, ovaries and presacral space, as well as unknown primary NETs
  • Bronchial carcinoid
  • Thymic carcinoid
  • Small cell lung carcinoma
  • large cell NEC of lung
  • Other poorly differentiated NECs (small and large cell NECs)
  • Well differentiated G3 NETs
  • Neuroendocrine prostate cancer (NEPC)
  • Merkel cell carcinoma
  • Paraganglioma/Pheochromocytoma
  • Adrenal Cortical Carcinoma
  • Medullary Thyroid Carcinoma
  • Mixed tumors (adenoneuroendocrine carcinomas, mixed acinar-neuroendocrine tumors, globlet cell carcinoid)

Types of therapeutic interventions

  • PRRT (Peptide Receptor Radionuclide Therapy)   Peptide refers to a small molecule that is very similar to the naturally occurring hormone somatostatin.   read more
  • Surgery  At UCSF, we have extensive experience evaluating patients and performing complex operations for neuroendocrine tumors.  read more
  • Liver-directed therapy
  • Somatostatin analogs
  • Oral targeted agents (e.g. everolimus, sunitinib, telotristat)
  • Chemotherapy
  • Other types of radiation therapy

 

Well-differentiated (having cells most like the surrounding tissue) metastatic tumors are treated with a range of interventions including: liver resection, other liver-directed therapy such as selective internal radiation therapy (SIRT) and hepatic artery chemo embolization (HACE), somatostatin analogs such as octreotide, biologically targeted agents and/or chemotherapy.

 

Peptide receptor radionuclide therapy (PRRT), a therapy in which radioactive material is combined with a cell-targeting protein and delivered directly to the tumor, is also effective. This therapy was first offered in Europe and now offered at UCSF via clinical trial. It is expected that this will be approved by the FDA and available as standard of care treatment in the near future.

High grade NECs are typically treated with chemotherapy according to the guidelines for small cell lung cancer, the most common type of high grade NEC.

June 2017, Dr. Emily Bergsland received the Ernest H. Rosenbaum, M.D., Commitment to Patient Care Award for her long-standing dedication to her patients and ongoing efforts to improve care for people with neuroendocrine tumors. The award recognizes clinicians who are deeply committed to the highest quality patient care.

 

In December 2016, Dr. Thomas Hope received the first NETRF/ERF Nuclear Medicine Pilot Research Grant. The Neuroendocrine Tumor Research Foundation (NETRF) established the grant to explore innovations in nuclear medicine focused on diagnosis and treatment. The Education and Research Foundation for Nuclear Medicine and Molecular Imaging (ERF) solicited proposals and convened the scientific review panel to select the recipient. Hope’s project is titled “Intra-Arterial Peptide Receptor Radionuclide Therapy (I-A PRRT) using 90Y DOTA-TOC.” The primary goals are to evaluate possible liver, bone marrow and kidney toxicity after hepatic arterial injection and to evaluate imaging tumor response three months after treatment. Dr. Hope’s principal co-investigators are Dr. Emily Bergsland and Dr. Nicholas Fidelman.

 

In 2016, the Neuroendocrine Tumor Research Foundation recognized Dr. Eric Nakakura for his projected titled “Development of a Mouse Model of Pancreatic Neuroendocrine Cancer.” His xenograft mouse model will be useful in helping develop and test potential new therapies for pancreatic neuroendocrine tumors.

 

In 2016, the Neuroendocrine Tumor Research Foundation named Dr. Michael Germanthe NETRF Petersen Investigator for his project titled, “Treating Neuroendocrine Tumors via Synthetic Lethality.” His research aims to analyze how certain pathways interact to control neuroendocrine cell survival and death, and to evaluate synthetic lethal interactions—a gene therapy targeting cancer cells—in a patient-derived xenograft tumor model of pancreatic neuroendocrine tumors.

 

What is PRRT?

PRRT (177Lu-DOTATATE) is currently available at UCSF.

For evaluation, please request an appointment.

PRRT stands for Peptide Receptor Radionuclide Therapy.  Peptide refers to a small molecule that is very similar to the naturally occurring hormone somatostatin.  We call it a somatostatin analog, meaning that it is similar but not identical to somatostatin.  There are a number of somatostatin analogs that are use in patients with neuroendocrine tumors including octreotide, sandostatin, lanreotide.  These peptides bind to the somatostatin receptor that is expressed on the majority of neuroendocrine tumor cells. 

 

When binding to these receptors the peptide is brought into the tumor cell and stays there.  Because neuroendocrine tumor cells are one of the few cells in the body that express somatostatin receptors, we are able to target our peptide to the tumor cells using the receptor.  Radionuclide refers to the radiation that we attach to the peptide. 

 

There are different types of radiation that we can use, but in PRRT all the radiation given off is the type that can be used to kill cells.  Therapy refers to the idea that we are using peptides to target the receptors and bring the radionuclide into the tumor cells in order to treat the cells.  That is PRRT.

 

 

Published guidelines for treatment of NETs

UCSF Drs. Eric Nakakura and Emily Bergsland discuss carcinoid syndrome on ITV

 June 20, 2016

 

Dr. Emily Bergsland - NET Primer

January 24, 2016

 

The Patient & Family Neuroendocrine Tumor (NET) 2016 Conference

January 2016, Mission Bay Conference Center

Hosted by the HDFCCC in cooperation with NorCal CarciNET, NET Research Foundation, and Stanford University Medical Center