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NICE recommends targeted treatment for neuroendocrine tumours in the liver

New guidance from the National Institute for Health and Care Excellence (NICE) means that people with neuroendocrine tumours (NETs) in the liver could benefit from a therapy treatment that targets tumours with radiation while limiting exposure to healthy surrounding tissue.1

NETs are cancers of neuroendocrine cells, commonly spread from organs such as the gastrointestinal tract or pancreas, to the liver. The guidance is significant as it offers another option for healthcare professionals to treat patients within the NHS. Selective Internal Radiation Therapy (SIRT), a procedure which takes one to two hours, involves injecting tiny radioactive spheres into the artery that takes blood to the liver. These microspheres deliver targeted radiation that kills the cancer cells.

NICE reviewed the evidence on the safety and efficacy of SIRT, which included TheraSphere™ Y90 Microspheres2. NICE found that SIRT may result in fewer side effects, faster recovery times, and better quality of life for patients compared with surgery or chemotherapy.

NICE recommended that a multidisciplinary team experienced in managing NETs should select the patient and carry out the procedure in specialist centres by clinicians trained and experienced in delivering SIRT. If there are cases where SIRT cannot completely eradicate the cancer, it can still be used to reduce the tumour size and control symptoms of the disease.

Until now, treatment options for NETs in the liver include surgical resection, percutaneous ablation, and systemic chemotherapy. Some of these tumours may release hormones which cause severe symptoms such as diarrhoea, fast heart rate and breathlessness which are clinically referred to as carcinoid syndrome.

About 6,000 people are diagnosed with NETs in the UK every year, while others face long delays in getting diagnosed.3 Patients with NETs in the liver tend to have less favourable outcomes compared with those experiencing NETs that has not spread to the liver as their tumours are more challenging to treat.4

Recent advances in SIRT have come from efforts to optimise the therapy by customising a high dose of radiation to target a patient’s tumour and delivering that dose in an extremely precise way while sparing healthy tissue. This highly personalised dosing, known as dosimetry, has been shown to improve outcomes for patients with liver cancer.4

A multidisciplinary team, comprising interventional and vascular radiologists and nuclear medicine specialists, collaborate using specialised software to share radiological images and dosimetry data to achieve effective dosing and treatment plans tailored to individual patients.

References

1 Interventional procedure overview of selective internal radiation therapy for neuroendocrine tumours that have metastasised to the liver, NICE, (nice.org.uk)

2 TheraSphere is a Boston Scientific SIRTthat was considered in NICE’s Interventional Procedure 1314 to treat neuroendocrine tumours in the liver

3 R. Basuroy et al, “Delays and routes to diagnosis of neuroendocrine tumours,” BNC Cancer18: 1122, May 2018.

4 E. Garin, et al, “Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial,” The Lancet Gastroenterology & Hepatology6:1, January 2021.

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Joanna Harvey
Joanna Harvey
Marketing and Communication Executive | Uniphar Commercial

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