Pneumologie 2011; 65 - P229
DOI: 10.1055/s-0031-1272223

Pulmonary neuroendocrine tumors: treatment need and new treatment options

W Engel-Riedel 1, J Zimmermann 1, C Ludwig 1, E Stoelben 1, M Thomas 2, M Serke 3, W Eberhardt 4, S Herbertz 5, C Hosius 6, J Stieglmaier 7
  • 1Kliniken der Stadt Köln
  • 2Thoraxklinik am Universitätsklinikum Heidelberg
  • 3Lungenklinik Hemer
  • 4Westdeutsches Tumorzentrum, Universitätsklinikum Essen
  • 5Pulheim
  • 6Nürnberg
  • 7Novartis Pharma GmbH

Objective: Neuroendocrine tumors (NET) of the lung can be divided in typical carcinoid (TC), atypical carcinoid (AT), large cell neuroendocrine carcinoma (LCNEC) and small cell lung carcinoma (SCLC). Carcinoids and LCNEC are rare tumors with a reported prevalence of approximately 3% among surgically resected lung cancers. There is only little information on the prevalence of lung NET and no treatment standards exist. Targeted therapy such as mTOR inhibitors is discussed as promising approach. Here we present data from one institution and new treatment options in clinical trials.

Patients and Methods: Retrospective analysis of 1,244 surgically resected lung cancer patients was performed in our institution (January 2007– March 2009). For patients with a diagnosis of TC, AT and LCNEC we compared the data in terms of age, sex, smoking habits and tumor stage.

Results: Among the resected patients 26 (2,1%) were diagnosed with TC, 7 with AT (0.6%) and 29 with LCNEC (2.3%). LCNEC highly correlated with smoking and patients were diagnosed at a later stage compared to those with carcinoids. Patients with TC and AT happened more likely to be women, never-smokers and were mainly diagnosed in Stage I. There was no significant difference in age between these groups.

RAD001 has proven efficacy for treatment of NETs. Based on the need for treatment options of patients with advanced lung NET, the following trials exploiting the mTOR pathway have been set up: One 4-arm phase II study to evaluate the efficacy and safety of SOM230 and RAD001 alone or in combination versus control in the treatment of patients with TC/AC. In addition, a combination trial of RAD001 and carboplatin/paclitaxel for LCNEC will start shortly in patients with advanced LCNEC.

Conclusions: Lung NET is rare. Retrospective analysis of this data allows us to differentiate between these patients in terms of prognosis. The importance of clinical trials is recognized and will be addressed in 2 clinical trials.