title: Pancreatic Neuroendocrine Neoplasms: Basic Biology, Current Treatment Strategies and Prospects for the Future.
abstract: Pancreatic neuroendocrine neoplasms (pNENs) are rare tumors accounting for only 1%-2% of all pancreatic tumors. pNENs are pathologically heterogeneous and are categorized into three groups (neuroendocrine tumor: NET G1, NET G2; and neuroendocrine carcinoma: NEC) on the basis of the Ki-67 proliferation index and the mitotic count according to the 2010 World Health Organization (WHO) classification of gastroenteropancreatic NENs. NEC in this classification includes both histologically well-differentiated and poorly differentiated subtypes, and modification of the WHO 2010 classification is under discussion based on genetic and clinical data. Genomic analysis has revealed NETs G1/G2 have genetic alterations in chromatin remodeling genes such asMEN1,DAXXandATRX, whereas NECs have an inactivation ofTP53andRB1, and these data suggest that different treatment approaches would be required for NET G1/G2 and NEC. While there are promising molecular targeted drugs, such as everolimus or sunitinib, for advanced NET G1/G2, treatment stratification based on appropriate predictive and prognostic biomarkers is becoming an important issue. The clinical outcome of NEC is still dismal, and a more detailed understanding of the genetic background together with preclinical studies to develop new agents, including those already under investigation for small cell lung cancer (SCLC), will be needed to improve the prognosis.
authors.affiliation: Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan. aohmoto@ncc.go.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ohmoto
authors.affiliation: Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan. hrokutan@ncc.go.jp.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Rokutan
authors.affiliation: Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan. syachida@ncc.go.jp.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yachida
mesh_terms: D018278:Carcinoma, Neuroendocrine / Q000473:pathology* / Q000628:therapy*; D002454:Cell Differentiation; D006801:Humans; D008954:Models, Biological; D010190:Pancreatic Neoplasms / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D015398:Signal Transduction
keywords: 2010 WHO classification; Ki-67 index; everolimus; mitotic count; pNEC; pNENs; platinum regimen; sunitinib; tumor differentiation; whole-exome sequence data