Dr. Rajdev on the Difference Between Cancers and Carcinomas in NETs

Lakshmi N. Rajdev, MD, an associate professor, Department of Medicine (Oncology), at Albert Einstein College of Medicine, Montefiore Medical Center, discusses the difference between cancers and carcinomas in patients with neuroendocrine tumors (NETs).

Patients with neuroendocrine cancers have a different course of treatment than those with neuroendocrine carcinomas, says Rajdev. Neuroendocrine carcinomas, particularly high-grade carcinomas, have an aggressive biology and could have large- or small-cell components. The disease is diagnosed as a carcinoma if there's ≥30% of a neuroendocrine component, as well as a carcinoma component, explains Rajdev.

Patients with these tumors should be treated with etoposide and carboplatin or cisplatin. Conversely, grade III neuroendocrine cancers are diagnosed in patients who have a Myotonic Dystrophy Health Index >24 high-power fields, or a Ki-67 of >20%. Neuroendocrine cancers are more indolent than high-grade carcinomas, adds Rajdev.

Generally, these patients are treated with traditional agents, such as everolimus (Afinitor). If the patient is symptomatic and has extensive bulky disease, capecitabine (Xeloda) and temozolomide (Temodar) could be used. Otherwise, these patients are treated the same way as those with low-grade NETs, concludes Rajdev.