A subset of pulmonary carcinoids shows well-differentiated morphology yet carries a high proliferative burden — defined by a mitotic count >10 and/or a Ki-67 index >20%. This combination places the tumour in a distinct subgroup that requires a different management approach compared with typical or atypical carcinoids with lower proliferative indices.
Well-differentiated lung carcinoid with high proliferative features: mitotic count >10 and/or Ki-67 index >20%. Despite the well-differentiated morphology, current evidence — including data from digestive neuroendocrine tumours and preliminary data in high-proliferative lung carcinoids — supports treating these patients similarly to aggressive atypical carcinoid, rather than as poorly differentiated carcinoma.
Recommended options for this rare subgroup include systemic therapy and, in selected patients, a receptor-targeted approach based on somatostatin receptor imaging findings. The choice among available first-line strategies depends on individual patient and tumour characteristics.
Full regimen detail, sequencing, and eligibility criteria available via the structured protocol below.DOI: 10.1016/j.annonc.2021.01.003
This new subgroup is defined by a mitotic count >10 and/or a Ki-67 index >20%, and a well-differentiated morphology.
Based on available data in digestive NETs (GEP-NET G3 subgroup) but also preliminary data in high proliferative LC, the authors recommend treating these patients like they have aggressive AC and not poorly differentiated carcinomas.
Everolimus, ChT and, in selected patients, PRRT, constitute the recommended options in this rare subgroup of patients [V C].
Upfront everolimus or dacarbazine/temozolomide-based or oxaliplatin-based ChT is recommended, or in selected subgroup PRRT (based on positive uptake at SRI on all RECIST-evaluable targets) in high proliferative ACs [V, C].
View source ↗