Continuous 5-fluorouracil infusion plus long acting octreotide in advanced well-differentiated neuroendocrine carcinomas. A phase II trial of the Piemonte Oncology Network

<p>Abstract</p> <p>Background</p> <p>Well-differentiated neuroendocrine carcinomas are highly vascularized and may be sensitive to drugs administered on a metronomic schedule that has shown antiangiogenic properties. A phase II study was designed to test the activity of protracted 5-fluorouracil (5FU) infusion plus long-acting release (LAR) octreotide in patients with neuroendocrine carcinoma.</p> <p>Methods</p> <p>Twenty-nine patients with metastatic or locally advanced well-differentiated neuroendocrine carcinoma were treated with protracted 5FU intravenous infusion (200 mg/m²daily) plus LAR octreotide (20 mg monthly). Patients were followed for toxicity, objective response, symptomatic and biochemical response, time to progression and survival.</p> <p>Results</p> <p>Assessment by Response Evaluation Criteria in Solid Tumors (RECIST) criteria showed partial response in 7 (24.1%), stable disease in 20 (69.0%), and disease progression in 2 patients. Response did not significantly differ when patients were stratified by primary tumor site and proliferative activity. A biochemical (chromogranin A) response was observed in 12/25 assessable patients (48.0%); symptom relief was obtained in 9/15 symptomatic patients (60.0%). There was non significant decrease in circulating vascular epithelial growth factor (VEGF) over time. Median time to progression was 22.6 months (range, 2.7-68.5); median overall survival was not reached yet. Toxicity was mild and manageable.</p> <p>Conclusion</p> <p>Continuous/metronomic 5FU infusion plus LAR octreotide is well tolerated and shows activity in patients with well-differentiated neuroendocrine carcinoma. The potential synergism between metronomic chemotherapy and antiangiogenic drugs provides a rationale for exploring this association in the future.</p> <p>Trial registration</p> <p>NCT00953394</p

Somatostatin analogues in the treatment of gastroenteropancreatic neuroendocrine tumours, current aspects and new perspectives

Gastroenteropancreatic neuroendocrine tumours (GEP NETs) are rare tumours that present many clinical features

The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours

Peptide receptor radionuclide therapy (PRRNT) is a molecularly targeted radiation therapy involving the systemic administration of a radiolabelled peptide designed to target with high affinity and specificity receptors overexpressed on tumours. PRRNT employing the radiotagged somatostatin receptor agonists (90)Y-DOTATOC ([(90)Y-DOTA(0),Tyr(3)]-octreotide) or (177)Lu-DOTATATE ([(177)Lu-DOTA(0),Tyr(3),Thr(8)]-octreotide or [(177)Lu-DOTA(0),Tyr(3)]-octreotate) have been successfully used for the past 15 years to target metastatic or inoperable neuroendocrine tumours expressing the somatostatin receptor subtype 2. Accumulated evidence from clinical experience indicates that these tumours can be subjected to a high absorbed dose which leads to partial or complete objective responses in up to 30 % of treated patients. Survival analyses indicate that patients presenting with high tumour receptor expression at study entry and receiving (177)Lu-DOTATATE or (90)Y-DOTATOC treatment show significantly higher objective responses, leading to longer survival and improved quality of life. Side effects of PRRNT are typically seen in the kidneys and bone marrow. These, however, are usually mild provided adequate protective measures are undertaken. Despite the large body of evidence regarding efficacy and clinical safety, PRRNT is still considered an investigational treatment and its implementation must comply with national legislation, and ethical guidelines concerning human therapeutic investigations. This guidance was formulated based on recent literature and leading experts’ opinions. It covers the rationale, indications and contraindications for PRRNT, assessment of treatment response and patient follow-up. This document is aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRNT and to deliver the treatment in a safe and effective manner. This document is largely based on the book published through a joint international effort under the auspices of the Nuclear Medicine Section of the International Atomic Energy Agency

Introduction

In the Introduction to the edited volume, Potter and Modlin briefly review the broad relationships between key concepts important for this volume: social memory, identity, heritage, and tourism. They then transition to the critical examination of methods that can be used to research social memory and heritage tourism, particularly in the discipline of Geography. Finally, they provide a brief synopsis of how each chapter addresses methods in the context of research within heritage tourism and/or memory

Searching for Slavery Amongst the Plantation Edutainment Complex

Cultural research on plantations has largely focused on the house tour and its representations of slavery ignoring the variety of other ways owners and operates commodify the site. This paper, based on research in South Carolina and Louisiana, explores the growing plantation edutainment complex. This developing plantation edutainment complex seeks to diversify methods to earn revenue in an increasingly competitive heritage tourism market. Utilizing interviews, analysis of plantation websites and promotional materials, as well as survey data this presentation will explore three ways that the plantation is commodified beyond the house tour: the ephemeral event (i.e. festival, wedding), the site itself with a variety of land uses (i.e. slave cemetery, petting zoo, campsite), and the creation of plantation brand. The authors will conclude by considering the ramifications to responsibly remembering slavery when it is but one component of a multi-faceted plantation business

Placing the Museum: Toward Museum Geography

Geographers are increasingly contributing to understanding the multiple functions museums serve, much like their colleagues in history, anthropology, and museum studies. In her 2010 article Museum Geography: Exploring Museums, Collections and Museum Practice in the UK, Hilary Geoghegan writes, Museums and collections offer geographers exciting sites and subjects for research and teachings [and] that it is now time to consider museum geography more closely (p. 1472). Heeding her call, this set of sessions is designed to serve as a conversation space to consider recent scholarship by geographers and others interested in the social spaces of museums. New and career scholars as well as non-academic museum stakeholders will participate in this set of sessions designed to consider 1) the changing roles of museums in various geographical settings, 2) the shifting challenges ­ legal, economic and issues of diversity ­faced by museums 3) analysis of the adoption of new forms of representation and embodiment at specific sites