Biomarker Study in Pancreatic Neuroendocrine Tumours

Study Overview
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Brief Summary
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The biology of pancreatic neuroendocrine tumors can change during the disease course. This evolution of disease can manifest through increases in tumor proliferation rate, resistance to medical therapy and/or a change in tumor hormone secretion. This study aims to characterize how the biology of pancreatic neuroendocrine tumors change over time, measured by; patient symptoms, biochemistry, contrast enhanced computed tomography, FDG-PET and core needle biopsy with histopathological analysis (Ki67 index and tumor cell differentiation). Uptake on 18F-FDG-PET will be correlated directly to tumor cell proliferation rate. Fraction of patients with spatial heterogeneity in FDG uptake as well as metachronous changes in all collected data will be documented. Biomaterial from whole blood and core needle biopsies will be characterized on the molecular level, and those findings will be integrated to the above specified clinical parameters.

Official Title
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Prospective Longitudinal Biomarker Study in Pancreatic Neuroendocrine Tumours

Conditions
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Neuroendocrine Tumors

Intervention / Treatment
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* Procedure: Core Needle Biopsy
* Radiation: Computed Tomography
* Radiation: 18F-FDG-PET
* Procedure: Phlebotomy
* Genetic: Molecular genetic analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥18 years Informed consent WHO performance status ≤2 Progressive disease (as defined by the local investigator) or newly diagnosed disease (defined as prior to medical or oncological intervention except for somatostatin analogue treatment). Pathology confirmed diagnosis of pancreatic or duodenal neuroendocrine tumour WHO G1-G3. o Exception: In newly diagnosed patients with high suspicion of PNET based on clinical and radiological parameters where tissue sample have not yet been obtained. These patients may be included and subsequently excluded if pathology cannot confirm NET. Biopsy procedure not associated with inappropriate risk as determined by the responsible physician. Exclusion Criteria: Patient does not consent Permanent risk factors for biopsy Long term treatment with anticoagulant that cannot be temporarily paused without unacceptable risk. Permanent coagulation disorder Pregnancy or no contraceptive in fertile women.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Core Needle Biopsy|Core Needle Biopsy is performed from liver metastasis.|
|Radiation: Computed Tomography|Computed Tomography|
|Radiation: 18F-FDG-PET|18F Fluorodeoxyglucose Positron emission tomography|
|Procedure: Phlebotomy|3 EDTA tubes drawn from peripheral vein|
|Genetic: Molecular genetic analysis|Performed on biomaterial from peripheral vein and core needle biopsy|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between FDG-PET and tumor biology | 18F-FDG-PET SUVmax correlation to Ki67 index (determined as percentage of tumor cells with positive Ki67 imunohistochemical staining). | Through study completion, an average of 3 years. |