Tumor biomarkers for diagnosis, prognosis and targeted therapy | Signal Transduction and Targeted Therapy

Refractory Neuroendocrine Tumor—response To Liposomal Doxorubicin And Capecitabine

Background. A 61-year-old patient with no relevant medical or family history presented with a 2 month history of refractory dry cough that led to the diagnosis of typical carcinoid tumor of the lung metastatic to the mediastinal lymph nodes and liver. She initially received a long-acting somatostatin analog (octreotide) and chemotherapy with cisplatin and etoposide, which was ineffective.

Investigations. Physical examination, laboratory test, chromogranin A test, CT scan, 111In-diethylenetriaminepentaacetic acid (DTPA)-octreotide scan, 18F-FDG-PET scan, fine-needle and tissue core liver biopsies.

Diagnosis. Pulmonary spindle-cell carcinoid tumor with metastases to mediastinal lymph nodes and liver.

Management. Systemic treatment with oral capecitabine (1,500 mg/m2 daily from day 1 to day 21) and intravenous liposomal doxorubicin (10 mg/m2 on days 1, 8 and 15), both repeated every 4 weeks, administered concomitantly with long-acting octreotide 30 mg every 3 weeks. The patient achieved a significant and long-lasting response with the combination of capecitabine and liposomal doxorubicin. She reported no severe adverse effects.

A Stepwise Approach To The Management Of Metastatic Midgut Carcinoid Tumor

Background. A 48-year-old man presented with diarrhea, flushing, abdominal pain and weight loss of 10 kg over a 6-month period. He subsequently developed dyspnea on exertion.

Investigations. Physical examination, laboratory tests, CT of the abdomen, liver biopsy, echocardiography, immunohistochemistry staining of the biopsy specimen for neuroendocrine markers including chromogranin A, synaptophysin and protein gene product 9.5, and 111In-pentetreotide scintigraphy (Octreoscan™).

Diagnosis. Carcinoid tumor of midgut origin with large segment 3 liver metastasis. Carcinoid syndrome and carcinoid heart disease.

Management. Symptomatic relief with somatostatin analog therapy and subsequent resection of the segment 3 liver metastasis. Tricuspid and pulmonary valve replacement.

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