Dior Marie, Dreanic Johann, Prieux-Klotz Caroline, Brieau Bertrand, Brezault Catherine, Coriat Romain
CHU Cochin, AP-HP, service de gastroentérologie, d'endoscopie digestive et d'oncologie digestive, 27, rue du Faubourg-St.-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, faculté de médecine, 75006 Paris, France.
CHU Cochin, AP-HP, service de gastroentérologie, d'endoscopie digestive et d'oncologie digestive, 27, rue du Faubourg-St.-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, faculté de médecine, 75006 Paris, France.
Presse Med. 2017 Jan;46(1):4-10. doi: 10.1016/j.lpm.2016.09.001. Epub 2017 Jan 11.
Mid gut neuroendocrine tumors (NET) are rare tumors whose incidence is increasing. Curative surgery remains the gold standard for the treatment of NETs of the small intestine. Surgery should be considered as soon as possible even if a metastatic stage is diagnosed. The management of unresectable well-differentiated metastatic NETs of the small intestine recently changed with the publication of trials demonstrating the benefit of targeted therapies and metabolic radiotherapy, leading to a change of practices and update of French and international recommendations.
The objective of this review is to present the recent data consisting of three phase III studies, which modify the management of well-differentiated metastatic midgut NETs and make an inventory of the available treatment options.
The documentary sources used were gathered through the PubMed website using keyword searching (neurendocrine tumor, mid gut, treatment). We also referred to recommendations of the European Society of neuroendocrine tumors (ENETS) trials presented at ESMO Congress 2015 (European Society for Medical Oncology).
We excluded studies of exclusive extra-digestive NETs, poorly differentiated NETs, surgical treatments and phase I studies.
We discussed three randomized phase III trials: CLARINET, RADIANT and NETTER studies. These studies demonstrated the efficacy of respectively somatostatin analogues, mTOR inhibitors and metabolic radiotherapy.
This review highlights the validation by randomized studies of an mTOR inhibitor and metabolic radiotherapy in metastatic non-pancreatic digestive NETs unresectable well-differentiated grade of G1/2 in progression under somatostatin analogues.
中肠神经内分泌肿瘤（NET）是罕见肿瘤，其发病率正在上升。根治性手术仍然是小肠NET治疗的金标准。即使诊断为转移阶段，也应尽快考虑手术。随着一些试验的发表，小肠不可切除的高分化转移性NET的治疗最近发生了变化，这些试验证明了靶向治疗和代谢放疗的益处，导致了治疗实践的改变以及法国和国际指南的更新。
本综述的目的是介绍最近由三项III期研究组成的数据，这些研究改变了高分化转移性中肠NET的治疗方法，并梳理了可用的治疗选择。
所使用的文献来源是通过PubMed网站使用关键词搜索（神经内分泌肿瘤、中肠、治疗）收集的。我们还参考了2015年欧洲肿瘤内科学会（ESMO）大会上展示的欧洲神经内分泌肿瘤学会（ENETS）试验的指南。
我们排除了仅关于消化外NET、低分化NET、手术治疗和I期研究的相关研究。
我们讨论了三项随机III期试验：CLARINET、RADIANT和NETTER研究。这些研究分别证明了生长抑素类似物、mTOR抑制剂和代谢放疗的疗效。
本综述强调了随机研究对mTOR抑制剂和代谢放疗在接受生长抑素类似物治疗进展中的转移性非胰腺消化性NET、不可切除的高分化G1/2级肿瘤中的有效性验证。
