Emerging Treatments for Advanced/Metastatic Pheochromocytoma and Paraganglioma.

Opinion Statement: The incidence of metastatic pheochromocytoma (PHEO) and paraganglioma (PGL) may occur in as many as 35% of patients particularly with PGL and even more frequently in those with specific mutations. Biochemical, morphological, and molecular markers have been investigated for use in...

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Published in:Current Treatment Options in Oncology Vol. 21; no. 11; pp. 1 - 19
Main Authors: Ilanchezhian, Maran, Jha, Abhishek, Pacak, Karel, Del Rivero, Jaydira
Format: review Journal Article
Published: Springer Nature Nov2020
Online Access:View this record in EBSCOhost
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      dt: Nov2020
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      pub: Springer Nature
      place: New York, New York
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        10.1007/s11864-020-00787-z
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        atl: Emerging Treatments for Advanced/Metastatic Pheochromocytoma and Paraganglioma.
      aug:
        au:
          Ilanchezhian, Maran
          Jha, Abhishek
          Pacak, Karel
          Del Rivero, Jaydira
        affil: Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
      sug:
        subj:
          Paraganglioma Therapy
          Adrenal Gland Neoplasms Therapy
          Pheochromocytoma Therapy
          Antineoplastic Agents Therapeutic Use
          Radiopharmaceuticals Therapeutic Use
          Cyclophosphamide Therapeutic Use
          Octreotide Acetate Therapeutic Use
          Surgery, Operative
          Paraganglioma Pathology
          Angiogenesis Inhibitors Therapeutic Use
          Vincristine Therapeutic Use
          Adrenal Gland Neoplasms Pathology
          Pheochromocytoma
          Antineoplastic Agents, Combined Therapeutic Use
          Liver Neoplasms
          Benzene Derivatives Therapeutic Use
          Octreotide Acetate Analogs and Derivatives
          Bone Neoplasms
          Dacarbazine Therapeutic Use
          Pheochromocytoma Pathology
          Lung Neoplasms
          Cytoreduction Surgical Procedures
          Liver Neoplasms Therapy
          Paraganglioma
          Bone Neoplasms Therapy
          Lung Neoplasms Therapy
          Clinical Assessment Tools
      ab: Opinion Statement: The incidence of metastatic pheochromocytoma (PHEO) and paraganglioma (PGL) may occur in as many as 35% of patients particularly with PGL and even more frequently in those with specific mutations. Biochemical, morphological, and molecular markers have been investigated for use in the distinction of benign from malignant PHEO/PGL. PHEO/PGL metastasizes via hematogenous or lymphatic routes and shows differences based on mutational status. The most common sites of involvement in patients that have an SDHB mutation are the bone (78%), lungs (45%), lymph nodes (36%), and liver (35%). In patients with sporadic PHEO/PGL, the most common sites of metastasis are the bones (64%), lungs (47%), lymph nodes (36%), and liver (32%). Metastases may be present at presentation or may occur later. Metastases to the liver and lungs are associated with a shorter survival. Overall, the estimated 5-year survival rates are between 34 and 74%. Currently, treatments for metastatic PHEO/PGL are essentially palliative. Surgery is potentially curative; however, tumor dissemination limits the chance for a curative resection. When surgical intervention is not amenable, the therapeutic options include radiolabeled MIBG (Azedra®-iobenguane 131 was recently FDA-approved for patients > 12 years and older with iobenguane scan positive) or systemic chemotherapy with cyclophosphamide, vincristine, and dacarbazine (CVD) with an overall objective response rate (ORR) of less than 40%; however, it is not clear if the administration of CVD impacts overall survival, as nearly all patients develop progressive and ultimately fatal disease. Other treatment modalities under investigation include cytoreductive techniques, novel radiopharmaceuticals, chemotherapy, radiotherapy, immunotherapy, and experimental therapies. Here we are discussing emerging treatment for advanced/metastatic PHEO/PGL.
      pubtype: Academic Journal
      doctype:
        review
        Journal Article
      ougenre: Article
    language: English
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