Other techniques may be used to destroy a tumor, and sometimes the techniques are used during a surgical procedure.
In ablation therapy, a probe is inserted directly into the tumor. Energy is passed through the probe, which heats the tumor cells beyond the boiling point and kills them, without damaging healthy tissue around the tumor. Carcinoid tumors respond quite well to ablation.
Ablation is much less invasive than surgery. Ablation is an outpatient procedure done under heavy sedation. Patients go home the same day with a Band-Aid. Surgeons can also perform ablation on patients during a surgical procedure.
Types of ablation include:
- Radiofrequency ablation (RFA): Uses electrical energy
- Microwave ablation: Uses microwave energy
- NanoKnife: The newest ablation technology, NanoKnife-irreversible Electroporation, destroys tumor cells using electrical energy without injuring critical blood vessels.
Embolization is a procedure that packs a one-two punch. The procedure sends anticancer agents directly into the tumor. The procedure also cuts off the blood supply to the tumor, effectively starving the tumor and keeping the treatment at the disease site. Carcinoid tumors tend to have a particularly rich blood supply, which makes them a particularly good candidate for embolization.
Embolization has relatively few side effects because the chemotherapy drugs or radiation are so localized and don’t travel throughout the body. Since it’s not as toxic as chemotherapy or radiation, embolization can be used when other treatments have failed without decreasing a person’s quality of life.
Embolization treatments generally are completed in two to three sessions.
Roswell Park offers two treatments using this approach:
- Chemoembolization: With chemoembolization, high doses of chemotherapy drugs are delivered directly to the tumor through its blood supply, then the blood vessel is blocked. Chemoembolization requires an overnight stay in the hospital.
- Radioembolization: With radioembolization, a high dose of radiation encased in tiny beads is sent directly to the tumor through a blood vessel that carries blood to the liver. The beads collect in the tumor and the isotope gives off radiation. This kills the cancer cells and destroys the blood vessels that the tumor needs to grow. Radioembolization is done on an outpatient basis.
Drugs called somatostatin analogs have been shown to control symptoms as well as slow down tumor cell growth. They can minimize the need for surgeries and other procedures. They are given as injections on an outpatient basis.
Patients with cancerous neuroendocrine tumors (NETs) affecting the digestive tract now have a new treatment option. On January 29, the Food and Drug Administration (FDA) approved a new targeted treatment, lutetium Lu 177 dotatate (Lutathera®), for adult patients with advanced Cancerous neuroendocrine tumors (NETs) that affect the pancreas or gastrointestinal tract, known as GEP-NETs. Lutetium Lu 177 dotatate is the first radioactive drug approved to treat these rare cancers.
Patients with GEP-NETs have limited treatment options if initial therapy fails to keep the cancer from growing or progressing. Lutathera provides a new treatment alternative for those NET patients who don’t respond to other treatments.
LUTATHERA® is a Lu-177-labeled somatostatin analog peptide. It is a type of molecular therapy known as Peptide Receptor Radionuclide Therapy (PRRT). It was approved by the FDA in January 2018, and by the European Commission in September 2017.
The new drug consists of a radioactive isotope, Lu-177, attached to dotatate—a molecule that binds to GEP-NET cells that have a molecule called a somatostatin receptor on their surface. The drug then enters these somatostatin receptor−positive tumor cells, and radiation emitted by Lu-177 helps kill the cells.
These drugs are generally given intravenously. They are used less often now that newer, less toxic oral drugs are available and have more favorable response rates. Interferon alpha (given as a subcutaneous injection) continues to be used for carcinoid tumors.
Novel Treatment Approaches
Recent clinical studies of novel agents have demonstrated promising activity in patients with advanced neuroendocrine tumors.
These tumors have aberrant signaling between cells, and newer therapies aim to block those signaling pathways. This would interfere with the growth and spread of neuroendocrine tumors.
Ongoing randomized studies should help better define the role these and other targeted agents will play in the future treatment of patients with this disease.