American Board of Internal Medicine (ABIM) Certification Practice Exam

Which systemic treatment is effective for patients with high-grade poorly differentiated neuroendocrine tumors?

1. Systemic platinum-based chemotherapy

2. Only targeted therapy

3. Radiation therapy

4. Monotherapy

The correct answer is: Systemic platinum-based chemotherapy

High-grade poorly differentiated neuroendocrine tumors (NETs) are aggressive neoplasms that typically require systemic treatment due to their proliferation and spread potential. Systemic platinum-based chemotherapy is considered the standard approach for managing these types of tumors because it targets rapidly dividing cells, which is characteristic of high-grade malignancies. This type of chemotherapy often includes agents such as cisplatin or carboplatin, and it is specifically geared towards improving the prognosis in patients with high-grade NETs. The rationale for using platinum-based chemotherapy stems from the cellular biology of these tumors, which tend to be more responsive to chemotherapeutic agents compared to lower-grade neuroendocrine tumors that might be more amenable to hormone therapy or targeted agents. Clinical studies have shown that platinum-based regimens can yield meaningful responses in patients with high-grade neuroendocrine tumors, providing an essential therapeutic option in this challenging scenario. Other options, such as targeted therapy or radiation therapy, may have specific roles in certain contexts or are used in conjunction with chemotherapy, but they are generally not the front-line treatment for high-grade poorly differentiated NETs due to their less robust clinical evidence of efficacy as monotherapies in these cases. Monotherapy alone would typically not be adequate due to the