Interesting Case Presentation

Neuroendocrine Lung Tumors

M. DemiriB Oncology Clinic Director

Saint Savvas Anticancer Hospital

• Male patient, 40 years old• No previous medical history• 6ος/2009: hemoptysis, imaging shows a left

lower pulmonary lobe mass. Patient was subjected to a left lower lobectomy.

• Pathology Report: neuroendocrine neoplasm; atypical carcinoid (AC) [mild cellular pleomorphism, necrosis, 3 mitoses/2 mm2, chromogranin +, NSE +, CD 56 +, CK8/18+]

• 6/2009 up to 7/2012: follow up

• 7 /2012: scheduled upper abdomen MRI: at least 22 new lesions with a maximum diameter about 1.5 cm in the left, right and caudate liver lobe, with abnormal signal intensity and contrast agent uptake.

• 10/2012: patient was admitted to the clinic for diagnostic workout and further treatment planning.– NSE, CA19-9, CEA, urine-5-HIAA: normal– Chromogranin: 108 ng/ml (normal values: in serum 10-110, in

plasma 18-150)

Due to their small size the liver lesions could not be biopsied under CT scan and a laparoscopic liver biopsy could not be done

11/2012: Octreoscan: diffuse abnormal uptake of the radioactive substance in the liver, which shows hyperexpression of somatostatin receptors, primarily sst2

• 11/2012: starts 1st line chemotherapy with CDDP 80 mg/m2 and Vepesid 100 mg/m2

• 1/2013: 3rd chemotherapy cycle, good tolerance, CT scan restaging: SD

• 4th cycle: exertional dyspnea. Heart U/S: marginally normal dimensions of the heart chambers and E.F. 60%. Strict fluid equilibrium control was advised as well as cardiology follow up before chemotherapy. CDDP was changed with CarboAUC5 from the 5th cycle.

• 4/2013: completion of 1st line chemotherapyRestaging: PD with increase in the dimensions of

most of the lesions which are noted in all the hepatic lobes, while one left lobe lesion presents a significant enlargement(4 cm from 1.5 cm)

• 5/2013: starts 2nd line chemotherapy with Xeloda- Temodal

• 9/2013: restaging: hepatic lesions remaining, with increase of the dimensions in certain and a decrease in others. Greater enlargement of the left lobe lesion (6 cm from 4 cm)

• 11/2013: restaging: SD• 02/2014: restaging: mild increase of the

dimensions in most lesions

• 04/2014: SD

• Other therapeutic options are – Everolimus + Somatostatin analog– Lu-Dotatate– LUNA trial (pasireotide)

Thank you for your attention.