title: A Delphic consensus assessment: imaging and biomarkers in gastroenteropancreatic neuroendocrine tumor disease management.
abstract: The complexity of the clinical management of neuroendocrine neoplasia (NEN) is exacerbated by limitations in imaging modalities and a paucity of clinically useful biomarkers. Limitations in currently available imaging modalities reflect difficulties in measuring an intrinsically indolent disease, resolution inadequacies and inter-/intra-facility device variability and that RECIST (Response Evaluation Criteria in Solid Tumors) criteria are not optimal for NEN. Limitations of currently used biomarkers are that they are secretory biomarkers (chromogranin A, serotonin, neuron-specific enolase and pancreastatin); monoanalyte measurements; and lack sensitivity, specificity and predictive capacity. None of them meet the NIH metrics for clinical usage. A multinational, multidisciplinary Delphi consensus meeting of NEN experts (n = 33) assessed current imaging strategies and biomarkers in NEN management. Consensus (>75%) was achieved for 78% of the 142 questions. The panel concluded that morphological imaging has a diagnostic value. However, both imaging and current single-analyte biomarkers exhibit substantial limitations in measuring the disease status and predicting the therapeutic efficacy. RECIST remains suboptimal as a metric. A critical unmet need is the development of a clinico-biological tool to provide enhanced information regarding precise disease status and treatment response. The group considered that circulating RNA was better than current general NEN biomarkers and preliminary clinical data were considered promising. It was resolved that circulating multianalyte mRNA (NETest) had clinical utility in both diagnosis and monitoring disease status and therapeutic efficacy. Overall, it was concluded that a combination of tumor spatial and functional imaging with circulating transcripts (mRNA) would represent the future strategy for real-time monitoring of disease progress and therapeutic efficacy.
authors: Uppsala UniversityUppsala, Sweden.
authors: Kjell
authors: K
authors: Oberg
authors: Erasmus Medical CenterRotterdam, Netherlands.
authors: Eric
authors: E
authors: Krenning
authors: Uppsala UniversityUppsala, Sweden.
authors: Anders
authors: A
authors: Sundin
authors: Memorial Sloan Kettering Cancer CenterNew York, New York, USA.
authors: Lisa
authors: L
authors: Bodei
authors: Wren LaboratoriesBranford, Connecticut, USA.
authors: Mark
authors: M
authors: Kidd
authors: Netherlands Cancer InstituteAmsterdam, Netherlands.
authors: Margot
authors: M
authors: Tesselaar
authors: University of BolognaBologna, Italy.
authors: Valentina
authors: V
authors: Ambrosini
authors: Zentralklinik Bad BerkaBad Berka, Germany.
authors: Richard P
authors: RP
authors: Baum
authors: Dana Farber Cancer InstituteBoston, Massachusetts, USA.
authors: Matthew
authors: M
authors: Kulke
authors: Charite HospitalBerlin, Germany.
authors: Marianne
authors: M
authors: Pavel
authors: University of Warmia and MazuryOlsztyn, Poland.
authors: Jaroslaw
authors: J
authors: Cwikla
authors: Wren LaboratoriesBranford, Connecticut, USA.
authors: Ignat
authors: I
authors: Drozdov
authors: Ospedale San RaffaeleMilan, Italy.
authors: Massimo
authors: M
authors: Falconi
authors: IEO (European Institute of Oncology)Milan, Italy.
authors: Nicola
authors: N
authors: Fazio
authors: Imperial College LondonLondon, UK.
authors: Andrea
authors: A
authors: Frilling
authors: National Institutes of HealthBethesda, Maryland, USA.
authors: Robert
authors: R
authors: Jensen
authors: Martini ZiekenhuisGroningen, Netherlands.
authors: Klaus
authors: K
authors: Koopmans
authors: Netherlands Cancer InstituteAmsterdam, Netherlands.
authors: Tiny
authors: T
authors: Korse
authors: Erasmus Medical CenterRotterdam, Netherlands.
authors: Dik
authors: D
authors: Kwekkeboom
authors: University Hospital FreiburgFreiburg, Germany.
authors: Helmut
authors: H
authors: Maecke
authors: Instituto Scientifico Romagnolo per lo Studio e la Cura dei TumoriMeldola, Italy.
authors: Giovanni
authors: G
authors: Paganelli
authors: Instituto Catala d'OncologiaBarcelona, Spain.
authors: Ramon
authors: R
authors: Salazar
authors: Instituto Scientifico Romagnolo per lo Studio e la Cura dei TumoriMeldola, Italy.
authors: Stefano
authors: S
authors: Severi
authors: H. Lee Moffitt Cancer CenterTampa, Florida, USA.
authors: Jonathan
authors: J
authors: Strosberg
authors: Charite HospitalBerlin, Germany.
authors: Vikas
authors: V
authors: Prasad
authors: University of VeronaVerona, Italy.
authors: Aldo
authors: A
authors: Scarpa
authors: Univeristy of OxfordOxford, UK.
authors: Ashley
authors: A
authors: Grossman
authors: University of GroningenGroningen, Netherlands.
authors: Annemeik
authors: A
authors: Walenkamp
authors: H. Lee Moffitt Cancer CenterTampa, Florida, USA.
authors: Mauro
authors: M
authors: Cives
authors: Medical University InnsbruckInnsbruck, Austria.
authors: Irene
authors: I
authors: Virgolini
authors: Copenhagen UniversityCopenhagen, Denmark imodlin@optonline.net.
authors: Andreas
authors: A
authors: Kjaer
authors: Yale UniversityNew Haven, Connecticut, USA imodlin@optonline.net.
authors: Irvin M
authors: IM
authors: Modlin
keywords: CT scan; CTC; Delphic consensus; MRI; NETest; PET; RECIST; biomarker; carcinoid; imaging; mRNA; multianalyte; neuroendocrine tumor; somatostatin