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Dr Halmos on Differentiating Neuroendocrine Tumors From Neuroendocrine Carcinomas

Supplements and Featured Publications, Broadening Awareness Around DLL3-Directed Therapies in Small Cell Lung Cancer and Neuroendocrine Carcinomas, Volume 1, Issue 1

Balazs Halmos, MD, discusses the differences in presentation and available treatments between neuroendocrine tumors and neuroendocrine carcinomas.

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    “Patients with NECs are at the very aggressive end of the differentiation spectrum. Recognizing these and hopefully now building on new treatment options for these patients will be very important.”

    Balazs Halmos, MD, associate director of clinical science at Montefiore Einstein Cancer Center; director of the Multidisciplinary Thoracic Oncology Program and director of the Section of Thoracic Medical Oncology for Montefiore Health Systems; as well as a professor in the Department of Oncology (Medical Oncology) and the Department of Medicine (Oncology & Hematology) and director of Clinical Cancer Genetics at the Albert Einstein College of Medicine, discussed the importance of differentiating between neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs).

    The distinction between NETs and NECs is clinically significant, Halmos began. Well-differentiated NETs, such as typical lung carcinoids or low-grade gastrointestinal NETs, are characteristically indolent and often follow a slow clinical course, he said. Importantly, the therapeutic paradigm for these tumors is expanding, he noted.

    In contrast, NECs represent the high-grade, poorly differentiated end of the neuroendocrine neoplasm spectrum, according to Halmos. These malignancies, which include entities like small cell lung cancer (SCLC) and large-cell neuroendocrine carcinoma, are defined histopathologically by features including poor cellular differentiation, elevated mitotic indices, and high Ki-67 proliferation levels, he explained. Although relatively uncommon, these tumors are encountered periodically in clinical practice, he stated.

    Current therapeutic strategies for patients with NECs often parallel those used for SCLC, including categorization by limited vs extensive stage and the use of platinum-based chemotherapy and immune checkpoint inhibitors for patients with metastatic disease, he reported. However, clinical outcomes remain poor, and treatment options are limited, he emphasized.

    Accurate recognition of NECs is essential for appropriate clinical decision-making, Halmos highlighted. Furthermore, there is a critical need to develop and refine therapeutic approaches specifically targeting this aggressive subset of neuroendocrine neoplasms to improve prognosis and expand clinical options, he concluded.


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