Precision Medicine in Phaeochromocytoma and Paraganglioma

Abstract

Precision medicine is a term used to describe medical care, which is specifically tailored to an individual patient or disease with the aim of ensuring the best clinical outcome whilst reducing the risk of adverse effects. Phaeochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumours with uncertain malignant potential. Over recent years, the molecular profiling of PPGLs has increased our understanding of the mechanisms that drive tumorigenesis. A high proportion of PPGLs are hereditary, with non-hereditary tumours commonly harbouring somatic mutations in known susceptibility genes. Through detailed interrogation of genotype-phenotype, correlations PPGLs can be classified into three different subgroups or clusters. Thus, PPGLs serve as an ideal paradigm for developing, testing and implementing precision medicine concepts in the clinic. In this review, we provide an overview of PPGLs and highlight how detailed molecular characterisation of these tumours provides current and future opportunities for precision oncology.

Keywords: molecular clusters; neuroendocrine tumours; paraganglioma; personalized medicine; phaeochromocytoma.

Figure 1

Provides an overview of how molecular classification can guide a personalized approach to PPGL patients. PARP: poly-(ADP)-ribose polymerase, mTOR: mechanistic Target of Rapamycin, MEK: mitogen-activated protein kinase kinase (MAP2K), TK: tyrosine kinase, MIBG: metaiodobenzylguanidine, PRRT: peptide receptor radionuclide therapy, SST: somatostatin.