Dr. Steven Libutti – Surgery In NET Cancer – Montefiore Hospital

 

 

Background NCI researcher in surgical oncology/NETs – Came back to work at new cancer center – Center for NET Cancer –

Prevalence is going up – why not sure

All nets can be stained – look at the tumor’s histology (what are the genes)

Now grouping tumor to molecular makeup not on location (NETs to the lung / not Lung Cancer)

Carcinoid Syndrome – Mostly for people with mets to liver – but can happen with lung and rectum

How do we treat – Many years the only tools were surgery –beginning to change with new agents

Carcinoid tumors can be very small – lymph node involvement may be the only way to detect – even with removal there may be microscopic METs that exists outside the primary area

Imaging – how do we find out where the tumors are even after surgery
OSCAN
FDG PET – more for PNET


CT or MRI is the mainstay for managing

First site of recurrence is in the Liver
Greatest hope is that they are resectable – via surgery or other methods – ablation

Hopkins research – surgical mgt of NET Tumors
Overall median survival – 125 months

Case slide – 1996 – patient presented with PNET – removed a modified whipple (although it should be called a Cameron procedure) – one step process that leaves part of the pancreas intact.  In 2005 after years of following – livers mets showed –resected a lobe – more tumors were found in dissected lobe – no doubt there are micro mets in the other lobe – need to have more management than just surgery

Liver transplant not viable on a large-scale population.
Need liver (hard to get) and stay on immunosuppressant rest of life

Schema IHP circuit –   Montefiore one of only two sites in US who do this - it is much like Chemo therapy direct to the liver – hook up the liver to the bypass machine for 60 minutes see the following link for a presentation.
PNETs and Carcinoid
Partial Response of 50%
PR Free is 7 months and overall survival is 48 months
Now trying via percutaneous – having great success

New Drugs that have been approved this year. 
Evrolimus (mTOR inhibitor)
Sutent – another pathway inhibitor

Combined Therapy – Surgery plus Evrolimus

Clinical Trial on SOM230 for Carcinoid with symptoms – This email address is being protected from spambots. You need JavaScript enabled to view it. 718-920-4231