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Pancreatic Neoplasms: HELP
Articles by Gregory A. Kaltsas
Based on 15 articles published since 2009
(Why 15 articles?)

Between 2009 and 2019, G. Kaltsas wrote the following 15 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
1 Guideline ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors. 2016

Falconi, M / Eriksson, B / Kaltsas, G / Bartsch, D K / Capdevila, J / Caplin, M / Kos-Kudla, B / Kwekkeboom, D / Rindi, G / Klöppel, G / Reed, N / Kianmanesh, R / Jensen, R T / Anonymous1590854. · ·Neuroendocrinology · Pubmed #26742109.

ABSTRACT: -- No abstract --

2 Review Advances and Current Concepts in the Medical Management of Gastroenteropancreatic Neuroendocrine Neoplasms. 2017

Alexandraki, Krystallenia I / Karapanagioti, Aggeliki / Karoumpalis, Ioannis / Boutzios, Georgios / Kaltsas, Gregory A. ·Clinic of Endocrine Oncology, Section of Endocrinology, Department of Pathophysiology, National and Kapodistrian University of Athens Medical School, Laiko University Hospital, Athens, Greece. · Department of Gastroenterology, Athens General Hospital "Georgios Gennimatas", Athens, Greece. ·Biomed Res Int · Pubmed #29349087.

ABSTRACT: Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare and heterogeneous group of tumors presenting as localised or metastatic disease and in a subset with distinct clinical syndromes. Treatment is aimed at controlling the functional syndrome, eradicating the tumor, and/or preventing further tumor growth. Surgery is the treatment of choice in removing the primary tumor and/or reducing tumor burden but cannot be applied to all patients. Somatostatin analogs (SS-analogs) obtain control of functional syndromes in the majority of GEP-neuroendocrine tumors (NETs); phase III trials have shown that SS-analogs can be used as first-line antiproliferative treatment in patients with slow-growing GEP-NETs. The role of the recently approved serotonin inhibitor, telotristat ethyl, and gastrin receptor antagonist, netazepide, is evolving. Streptozotocin-based chemotherapy has been used for inoperable or progressing pancreatic NENs but the orally administered combination of capecitabine/temozolomide is becoming more popular due to its better tolerability and potential effect in other GEP-NENs. Phase III trials have shown efficacy of molecular targeted therapies in GEP-NETs and of radionuclide treatment in patients with midgut carcinoid tumors expressing somatostatin receptors. Most patients will develop disease progression necessitating further therapeutic options. A combination of currently available treatments along with the molecular signature of each tumor will guide future treatment.

3 Review Pancreatic carcinoids (serotonin-producing pancreatic neuroendocrine neoplasms): Report of 5 cases and review of the literature. 2017

Tsoukalas, Nikolaos / Chatzellis, Eleftherios / Rontogianni, Dimitra / Alexandraki, Krystallenia I / Boutzios, Georgios / Angelousi, Anna / Kaltsas, Gregory. ·aDepartment of Medical Oncology, "401" General Military Hospital bEndocrine Unit, Department of Pathophysiology, National University of Athens cPathology Department, Evangelismos Hospital, Athens, Greece. ·Medicine (Baltimore) · Pubmed #28422824.

ABSTRACT: INTRODUCTION: Pancreatic neuroendocrine neoplasms (pNENs) are relatively rare tumors representing 1% to 2% of all pancreatic neoplasms. These tumors can secrete a variety of biologically active substances giving rise to distinct clinical symptoms or can be clinically nonfunctioning. Apart from insulinomas and gastrinomas, which constitute the majority of functioning pNENs, some tumors may secrete serotonin presenting with the features of the carcinoid syndrome. These so-called pancreatic carcinoids are considered relatively rare tumors and are associated with increased urinary levels of 5-hydroxyindoleacetic acid (5-HIAA). It has recently been suggested that the prevalence of such tumors might be underestimated. CASES: We present a series of 5 patients from our database of 138 pNENs (5/138, 3.62%), harboring serotonin-producing pNENs and describe their distinctive clinical, biochemical, histopathological features, and response to treatment along with a review of the relevant available literature. CONCLUSION: Such tumors are considered rare, although this may be an underestimate as systematic screening for the presence of serotonin in tissue or elevated urinary 5-HIAA levels in patients with apparently nonfunctioning pNENs is not currently recommended. In order to reach such a consensus, data from large prospective studies are needed in order to evaluate the impact of this type of tumors in survival and clinical outcome, since some studies have suggested a worse prognosis.

4 Review Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours. 2016

Dimitriadis, Georgios K / Weickert, Martin O / Randeva, Harpal S / Kaltsas, Gregory / Grossman, Ashley. ·The Arden NET CoEWarwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK Division of Translational and Experimental MedicineWarwick Medical School, University of Warwick, Coventry, UK Division of Endocrinology and Investigative MedicineImperial College London, Hammersmith Campus, London, UK g.dimitriadis@warwick.ac.uk. · The Arden NET CoEWarwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK Division of Translational and Experimental MedicineWarwick Medical School, University of Warwick, Coventry, UK Centre for Applied Biological and Exercise SciencesCoventry University, Coventry, UK. · The Arden NET CoEWarwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK Division of PathophysiologyNational and Kapodistrian University of Athens Medical School, Athens, Greece Oxford Center for DiabetesEndocrinology and Metabolism, University of Oxford, Oxford, UK. · Oxford Center for DiabetesEndocrinology and Metabolism, University of Oxford, Oxford, UK. ·Endocr Relat Cancer · Pubmed #27461388.

ABSTRACT: Although recent epidemiological evidence indicates that the prevalence of non-functioning gastroenteropancreatic (GEP) neuroendocrine tumours (NETs) is rising, a significant number of GEP-NETs still present with symptoms related to the secretion of biologically active substances leading to the development of distinct clinical syndromes. In the past, these syndromes were associated with substantial morbidity and mortality due to the lack of specific therapies; however, since the introduction of long-acting somatostatin analogues and medications such as proton pump inhibitors, their control has been greatly improved. As a result, nowadays, the main cause of morbidity and mortality in GEP-NETs is mostly directly related to tumour growth and the extent of metastatic disease. However, in some patients with functioning tumours and extensive disease, control of the secretory syndrome still remains problematic, necessitating the employment of several cytoreductive techniques, which may not always be sufficient. Recently, new agents directed against tumour growth, or exerting increased binding activity to receptors expressed in these tumours, or interfering with the synthetic pathway of some of the compounds secreted by these tumours, have been developed. Since there are no specific guidelines addressing the totality of the management of the secretory syndromes related to GEP-NETs, this review aims at critically analysing the medical management of previously recognised secretory syndromes; it also addresses areas of uncertainty, assesses the newer therapeutic developments and also addresses recently described but poorly characterised secretory syndromes related to GEP-NETs.

5 Review Laparoscopic surgery for pancreatic insulinomas: an update. 2016

Aggeli, Chrysanthi / Nixon, Alexander M / Karoumpalis, Ioannis / Kaltsas, Gregory / Zografos, George N. ·Third Department of Surgery, Athens General Hospital "Georgios Gennimatas", 154 Mesogeion Avenue, Athens, 11527, Greece. chraggeli@gmail.com. · Third Department of Surgery, Athens General Hospital "Georgios Gennimatas", 154 Mesogeion Avenue, Athens, 11527, Greece. · Department of Gastroenterology, Athens General Hospital "Georgios Gennimatas", Athens, Greece. · Department of Pathophysiology, Laiko Hospital, Athens, Greece. ·Hormones (Athens) · Pubmed #27376420.

ABSTRACT: Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity due to shorter length of hospital stay and better cosmetic results, with serious complications being comparable to those of open surgery. Preoperative localization is of paramount importance in the determination of the appropriate surgical approach. Many invasive and non-invasive methods exist for localization of an insulinoma. A combination of these modalities is usually adequate to preoperatively localize the vast majority of tumors. Laparoscopic ultrasound is mandatory to localize these tumors intraoperatively. Despite extensive experience in highly specialized centers producing encouraging results, no randomized trials have been realized to conclusively validate these case series, this partly due to the rarity of insulinoma in the population. In this article we present the current state of laparoscopic management of insulinoma delineating still unanswered issues and we underscore some of the technical details of the most common laparoscopic procedures employed.

6 Review Neoadjuvant therapy for advanced pancreatic neuroendocrine tumors: an emerging treatment modality? 2016

Perysinakis, Iraklis / Aggeli, Chrysanthi / Kaltsas, Gregory / Zografos, George N. ·Third Department of Surgery, General Hospital "G. Gennimatas",Athens, Greece. · Third Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece. · Department of Pathophysiology, National University of Athens, Athens, Greece. ·Hormones (Athens) · Pubmed #26732156.

ABSTRACT: OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders. DESIGN: We searched MEDLINE for the purpose of identifying reports regarding neoadjuvant treatment modalities for advanced pancreatic neuroendocrine tumors. RESULTS: We identified 12 studies, the vast majority of which were either case reports or small case series. Treatment options included chemotherapy, radiotherapy, peptide receptor radionuclide therapy, biological agents or various combinations of them. CONCLUSIONS: Increasing evidence supports the application of neoadjuvant protocols in advanced pancreatic neuroendocrine tumors aiming at tumor downsizing, thus rendering curative resection feasible. Given that prospective and controlled randomized clinical trials from high-volume institutions are not feasible, expert panel consensus is needed to define the optimal treatment algorithm.

7 Review Biochemical markers for gastroenteropancreatic neuroendocrine tumours (GEP-NETs). 2012

Kanakis, George / Kaltsas, Gregory. ·University of Athens Medical School, Athens, Greece. geokan@endo.gr ·Best Pract Res Clin Gastroenterol · Pubmed #23582919.

ABSTRACT: Biochemical markers are applied in gastroenteropancreatic neuroendocrine tumours (GEP-NETs) for diagnostic, prognostic or predictive purposes. Chromogranin A is the most important general marker and it is recommended to be measured in every patient with a suspected NET, whereas Neuron Specific Enolase is elevated mainly in poorly differentiated NETs. Pancreatic Polypeptide is used in the diagnosis of pancreatic non-functioning NETs, whereas Chorionic Gonadotrophin has an adjunctive role. In the case of functioning tumours, specific markers should be sought and monitored during follow up. Endogenous hyperinsulinemia is suggested in the presence of non-suppressible insulin and proinsulin levels during hypoglycemia, whereas high fasting or stimulated gastrin levels along with elevated gastric acid output are diagnostic for the Zollinger-Ellison syndrome. Glucagon, vasoactive intestinal polypeptide (VIP) and somatostatin are markers for glucagonoma, VIP-oma and somatostatinoma syndromes respectively. In case of ectopic paraneoplastic syndrome, the relevant hormone serves as a diagnostic and prognostic marker.

8 Review Gastroenteropancreatic neuroendocrine tumors: new insights in the diagnosis and therapy. 2012

Alexandraki, Krystallenia I / Kaltsas, Gregory. ·Department of Pathophysiology, National University of Athens, Mikras Asias 75, 11527, Athens, Greece. ·Endocrine · Pubmed #22124940.

ABSTRACT: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are relatively rare and heterogenous malignancies. Recent advances in histopathological classification according to the anatomical site of origin, proliferation rate, and extend of the disease have created a valid and powerful tool for the prognostic stratification of GEP-NETs. Chromogranin A is still the best available marker used for the biochemical confirmation of these tumors, but new more sensitive markers are urgently required. Although scintigraphy with (111)In-octreotide has widely been applied for the localization and staging of GEP-NETs, newer imaging modalities based on the functional characteristics of these tumors are evolving aiming not only to facilitate the diagnosis but also prognosis and evaluation of treatment. Somatostatin receptors are the primary therapeutic targets through somatostatin analogs and peptide receptor radionuclide therapy (PRRT) producing symptomatic, biochemical and to a lesser extent antiproliferative effects. Due to the relatively limited and erratic response to chemotherapy, new molecular targeted therapies exploiting some of the biological properties of GEP-NETs such as increased vascularity and inhibition of pathways involved in downstream signal transduction have evolved. Some of these therapies, the mTOR inhibitor everolimus and the tyrosine kinase inhibitor sunitinib, have been recently validated in phase III studies producing practice changing outcomes. In addition, two oral chemotherapeutic agents temozolomide and capecitabine, show promising effects and may replace streptozotocin-based regimens whereas combination therapies with the angiogenesis inhibitor bevacizumab are being investigated. Although progression free survival is used as a feasible primary end point due to the long survival of patients even in the presence of extensive disease prolongation of overall survival following the introduction of new therapies needs to be established.

9 Article Malignant hypercalcaemia related to parathyroid hormone-related peptide (PTHrP) secretion from a metastatic pancreatic neuroendocrine tumour (NET). 2017

Symington, Megan / Davies, Louise / Kaltsas, Gregory / Weickert, Martin O. ·The ARDEN NET Centre, ENETS CoE, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. ·BMJ Case Rep · Pubmed #28331027.

ABSTRACT: A 54-year-old woman presented to our centre with acute abdominal pain and vomiting. Routine blood tests showed severe hypercalcaemia (>4 mmol/L). Serum parathyroid hormone (PTH) was suppressed. CT scan detected a pancreatic mass and some liver lesions, initially suspicious for metastatic pancreatic adenocarcinoma. Liver biopsy however revealed the presence of a well-differentiated, grade 1, metastatic neuroendocrine tumour (NET) where prognosis is considerably better. Serum PTHrP was raised, indicating paraneoplastic hypercalcaemia, most likely secondary to the pancreatic NET. Following injection of a short-acting somatostatin analogue octreotide, serum PTHrP levels normalised within 24 hours, causing a rapid drop of serum calcium below the lower limit of normal and an immediate compensatory rise of serum PTH. Ongoing treatment with long-acting somatostatin analogues together with replacement with calcium carbonate, vitamin D3 and once weekly alendronic acid resulted in stable normal adjusted calcium levels over a 3-month follow-up period.

10 Article Sequential Everolimus and Sunitinib Treatment in Pancreatic Metastatic Well-Differentiated Neuroendocrine Tumours Resistant to Prior Treatments. 2017

Angelousi, Anna / Kamp, Kimberly / Kaltsatou, Maria / O'Toole, Dermot / Kaltsas, Gregory / de Herder, Wouter. ·Sector of Endocrinology, Department of Pathophysiology, National & Kapodistrian University of Athens, Athens, Greece. ·Neuroendocrinology · Pubmed #28122378.

ABSTRACT: OBJECTIVE: Alternating treatment with sunitinib and everolimus has been shown to be efficacious in renal cell carcinoma. However, no data currently exist for the role of alternate sequence administration of these agents in well-differentiated pancreatic neuroendocrine tumours (pNETs). METHODS: Thirty-one patients were administered one compound and upon progression were switched to the other. All patients had grade 1 or 2 tumours and stage IV disease with similar metastatic load. The primary end point included estimation of the median overall progression-free survival (mPFS) along with each drug's mPFS as a first-line (mPFS1) and a second-line treatment (mPFS2); tolerability and serious adverse events were also evaluated. Secondary end points included overall survival (OS), 2-year mortality rate, and incidence of disease progression. RESULTS: Overall, mPFS did not differ between the everolimus to sunitinib group (36.5 months) and the sunitinib to everolimus group (31.6 months) with a hazard ratio of 0.94 ([95% CI, 0.45-1.97], p = 0.7). Although mPFS1 after first-line everolimus was longer (16.3 months) compared to sunitinib (9 months), this was not statistically significant (p = 0.15). Sequential second-line treatment showed no difference in the mPFS2 (p = 0.3). No difference in OS between the 2 groups was observed. Tolerability was better for everolimus compared to sunitinib. CONCLUSIONS: Treatment with sequential molecular target agents was well tolerated and associated with similar overall mPFS in both schemes of administration. Larger prospective studies are required to investigate the long-term efficacy and sequence of administration of alternate therapy with molecular targeting agents in metastatic pNETs and their effect on OS.

11 Article Safety and efficacy of everolimus in gastrointestinal and pancreatic neuroendocrine tumors after (177)Lu-octreotate. 2013

Kamp, Kimberly / Gumz, Brenda / Feelders, Richard A / Kwekkeboom, Dik J / Kaltsas, Gregory / Costa, Frederico P / de Herder, Wouter W. ·Sector of Endocrinology, Department of Internal Medicine Department of Nuclear Medicine, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands Centro de Oncologia, Hospital Sírio Libanês, São Paulo, Brazil Department of Pathophysiology, National University of Athens, Athens, Greece. ·Endocr Relat Cancer · Pubmed #24036133.

ABSTRACT: Although (177)Lu-octreotate is an effective treatment for patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs), some patients will fail or develop disease progression necessitating further treatment. We examined whether the safety and efficacy of everolimus after prior treatment with (177)Lu-octreotate is different from the published safety profile of everolimus in GEP-NETs. In this multicenter study, 24 GEP-NET patients were included. Adverse events were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Tumor response was measured according to the Response Evaluation Criteria in Solid Tumors (RECIST), version 1.0. Major clinical adverse events (grade 3 or 4) during treatment with everolimus were hyperglycemia (20.8%), fatigue (8.3%), thrombocytopenia (8.3%), and elevated alanine transaminase levels (8.3%). By radiological review, there were four partial responses (16.7%), five patients (62.5%) with stable disease, and three patients (12.5%) with progressive disease. For two patients (8.3%), no data on tumor response were available. Median progression-free survival (PFS) was 13.1 months (95% CI, 11.5-21.2). Median PFS of the current study was longer when compared with the RADIANT-3 trial (13.1 vs 11.4 months) and shorter when compared with the RADIANT-1 trial (13.1 vs 16.7 months). In conclusion, the safety profile of everolimus is not influenced by previous treatment with peptide receptor radiotherapy.

12 Article The prevalence and relevance of adrenal masses in patients with sporadic gastroenteropancreatic neuroendocrine tumours (GEP-NET). 2013

Kanakis, George / Kamp, Kimberly / Tsiveriotis, Konstantinos / Feelders, Richard A / Zormpala, Alexandra / de Herder, Wouter W / Kaltsas, Gregory. ·Department of Pathophysiology, Endocrine Unit, University of Athens Medical School, Athens, Greece. geokan@endo.gr ·Clin Endocrinol (Oxf) · Pubmed #22970733.

ABSTRACT: OBJECTIVE: The widespread application of abdominal computerized tomography (CT) imaging has revealed that 0.98-4.0% of individuals harbour adrenal lesions (incidentalomas). There is, however, paucity of information regarding the prevalence of adrenal lesions in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETS). Purpose of this study was to estimate the prevalence of adrenal lesions in patients with GEP-NETS and identify their radiological features and clinical significance. DESIGN: The prevalence of adrenal lesions was estimated retrospectively in 438 patients with GEP-NETS who underwent abdominal imaging. Secretory status and changes in size were documented during subsequent follow-up. MEN-1 patients and ectopic ACTH-secreting tumours were excluded. RESULTS: Adrenal lesions were detected in 32 (8.4%) of 383 patients included. The majority (22 patients - 69%) were located at the left adrenal gland and the mean size was 23.6 mm. In two patients, one with a well and another with a poorly differentiated tumour, clinicopathological features suggested adrenal metastases. During a mean follow-up period of 69.5 months, no subsequent growth of any adrenal lesion was observed. Endocrine evaluation documented subclinical glucocorticoid hypersecretion in 4 cases (14%). The presence of adrenal lesions did not correlate to distant metastases, however, they were observed more frequently in patients with G3 tumours. CONCLUSION: The prevalence of adrenal lesions in patients with GEP-NETs was found to be higher than the general population and mostly represent benign adrenal adenomas (except patients with G3 tumours). Nevertheless, individualized assessment of imaging characteristics should be still considered.

13 Article Unusual complication of a pancreatic neuroendocrine tumor presenting with malignant hypercalcemia. 2012

Kanakis, G / Kaltsas, G / Granberg, D / Grimelius, L / Papaioannou, D / Tsolakis, A V / Öberg, K. ·Department of Pathophysiology (Endocrine Unit), University of Athens Medical School, Mikras Asias 75, 11527, Athens, Greece. geokan@endo.gr ·J Clin Endocrinol Metab · Pubmed #22319031.

ABSTRACT: CONTEXT: Hypersecretion of PTHrP is a relatively common cause of malignancy-related hypercalcemia but has only been described in a few cases of neuroendocrine tumors (NET). OBJECTIVE: The aim of this case report is to describe the clinical syndrome, complex therapeutic interventions, and unusual complications caused by persistent PTHrP hypersecretion in a patient with a pancreatic NET. CASE ILLUSTRATION: A 58-yr-old male patient presented with nonspecific abdominal pain and was found to have severe hypercalcemia secondary to a well-differentiated NET of the pancreas associated with extensive liver metastases. Elevated ionized calcium levels accompanied by low serum PTH and remarkably elevated PTHrP concentrations were consistent with PTHrP-related hypercalcemia that proved to be resistant to various chemotherapeutic regimens and supportive therapy. Partial control of the humoral syndrome was obtained only after the application of cytoreductive interventions and the introduction of various molecular targeted therapies. Due to persistent PTHrP action, bone disease emerged in the form of brown tumors. DISCUSSION: The manifestation of paraneoplastic syndrome due to PTHrP hypersecretion, despite its rareness in NET, should be considered in the differential diagnosis of hypercalcemia in such tumors. Moreover, the appearance of bone lesions in this setting may be in the context of metabolic bone disease and could be misdiagnosed as bone metastases.

14 Article ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. 2012

Jensen, Robert T / Cadiot, Guillaume / Brandi, Maria L / de Herder, Wouter W / Kaltsas, Gregory / Komminoth, Paul / Scoazec, Jean-Yves / Salazar, Ramon / Sauvanet, Alain / Kianmanesh, Reza / Anonymous60716. ·Digestive Diseases Branch, NIH, Bethesda, MD 20892, USA. robertj@bdg10.niddk.nih.gov ·Neuroendocrinology · Pubmed #22261919.

ABSTRACT: -- No abstract --

15 Minor Diagnostic accuracy and clinical significance of the fine needle aspiration Ki-67 labelling index in pancreatic endocrine tumours. 2011

Kaklamanos, Michail / Karoumpalis, Ioannis / Salla, Charitini / Thomas, Dimitrios / Kanakis, George / Alexandraki, Krystallenia / Sougioultzis, Stavros / Diakatou, Evanthia / Kontogeorgos, George / Kaltsas, Gregory. · ·Endocr Relat Cancer · Pubmed #22034543.

ABSTRACT: -- No abstract --