Interventional Oncology

Session: Educational Exhibit Presentations - Station 6: Interventional Oncology

Second Line Therapy for Neuroendocrine Tumor Liver Metastases: Where do Transarterial Therapies Belong?

Monday, March 6, 2023

5:50 PM – 5:55 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Aryan Hemani, B.S. (he/him/his)

Medical Student
Spartan Health Sciences University, Saint Lucia

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Cynthia De La Garza Ramos, MD

Interventional Radiology Resident
Department of Radiology, Division of Interventional Radiology, Mayo Clinic, Jacksonville, FL 32224, United States
JS

Jason Starr, D.O.

Medical Oncologist
Division of Hematology/Oncology, Mayo Clinic, Jacksonville, Florida, USA
JC

Jacob Core, DO

Consultant
Department of Radiology, Division of Interventional Radiology, Mayo Clinic, Jacksonville, FL 32224, United States
Beau B. Toskich, MD, FSIR

Professor
Department of Radiology, Division of Interventional Radiology, Mayo Clinic, Jacksonville, FL 32224, United States

Disclosure(s):

Aryan Hemani, B.S.: No financial relationships to disclose

Cynthia De La Garza Ramos, MD: No financial relationships to disclose

Beau B. Toskich, MD, FSIR: No relevant disclosure to display

Learning Objectives:

Explore the role of locoregional therapy (LRT) for neuroendocrine tumor liver metastases (NELM) in the setting of emerging systemic therapies

Discuss selection criteria and treatment intent for LRT to maximize outcomes and minimize adverse events

Summarize reported outcomes of radioembolization for NELM

Should peptide receptor radionuclide therapy (PRRT) even be considered when a liver-predominant pattern of disease is present?

Background: Neuroendocrine tumors (NET) are rare neoplasms typically of gastroenteropancreatic or pulmonary origin. Aside from the primary site, tumors are classified by functional status, presence or absence of metastasis, degree of differentiation, and proliferative activity. Patients commonly present with stage IV disease, with the liver as the most frequent site of metastasis.

Surgery for NELM is often reserved for low-grade, well-differentiated tumors with favorable size and distribution characteristics. Somatostatin analogues (SSA) are typically employed as first-line therapy for non-surgical candidates. For second-line therapy, guidelines support systemic therapy with mTOR/protein-tyrosine kinase inhibition, cytotoxic chemotherapy with capecitabine-temozolomide, PRRT, or LRT such as percutaneous ablation or transarterial therapy. Further LRT indications include bulk-related symptoms, symptomatic on first-line SSA, or progression on a second-line systemic agent.

Clinical Findings/Procedure Details: This exhibit explores the role of LRT for NELM, with a focus on radioembolization and bland embolization, and discusses optimal patient selection. We summarize key LRT outcomes, including imaging response and patient survival. Optimal treatment parameters and expected imaging response characteristics are discussed and illustrated with case examples. Lastly, we discuss whether LRT or PRRT should be used as second-line therapy for NELM, particularly when there is a liver-predominant metastatic pattern.

Conclusion and/or Teaching Points: Unresectable NELM can benefit from multiple therapies; the decision requires local expertise and multidisciplinary discussion. Bland embolization and radioembolization are useful therapies for NELM with unique capabilities for both symptom and tumor control.