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Erika Peverelli Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

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Donatella Treppiedi Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

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Giovanna Mantovani Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy

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pharmacological options, the somatostatin receptor (SSTR) ligand pasireotide is the only approved pituitary tumor-targeted drug for the treatment of CD in adult patients ( Colao et al. 2012 ). SSTR family includes five different receptor subtypes (SSTR1

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Elisa Lamback Neuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil

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Renan Lyra Miranda Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil

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Leila Chimelli Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil

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Felipe Andreiuolo Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil

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Leandro Kasuki Neuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil

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Luiz Eduardo Wildemberg Neuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil

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Mônica R Gadelha Neuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil

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consider the adenoma as a co-secreting tumor ( Dottermusch et al. 2024 ). Our artificial intelligence model predicted an 83% chance of not responding to first-generation somatostatin receptor ligand (fg-SRL) ( Wildemberg et al. 2021 ). Intramuscular

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Donatella Treppiedi Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

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Rosa Catalano Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

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Federica Mangili Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

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Giovanna Mantovani Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

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Erika Peverelli Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

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, FLNA may play opposite roles by differently regulating growth, invasion and metastasis ( Shao et al. 2016 ). The relevance of FLNA in PitNETs relies on its ability to bind dopamine receptor type 2 (DRD2), somatostatin receptor type 2 (SSTR2) and 5

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Jose E Nunez Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Sylvia Ng Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Hanbo Chen Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Simron Singh Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Julie Hallet Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Calvin Law Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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Sten Myrehaug Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

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heterogeneous clonal subpopulations that contribute to instances of non-response, either through reduced cell-surface somatostatin receptors (SSTR) or other mechanisms of treatment resistance ( Walter et al. 2018 , Puranik et al. 2021 ). Furthermore

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Syed Ehsanullah Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
Siteman Cancer Center, St Louis, Missouri, USA

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Nikolaos A Trikalinos Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
Siteman Cancer Center, St Louis, Missouri, USA

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mesenteric vein (SMV). Based on a concern for adenocarcinoma histology, he underwent endoscopic ultrasound-guided biopsy demonstrating PanNEN with a Ki-67 of 10%. A gallium dotatate PET/CT showed somatostatin receptor avid primary pancreatic malignancy with

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Joel George Hampshire Hospitals NHS Trust, Basingstoke, United Kingdom of Great Britain and Northern Ireland

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John Ramage Hampshire Hospitals NHS Trust, Basingstoke, United Kingdom of Great Britain and Northern Ireland

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Benjamin White Hampshire Hospitals NHS Trust, Basingstoke, United Kingdom of Great Britain and Northern Ireland

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Rajaventhan Srirajaskanthan Kings Health Partners NET Centre of Excellence, London, United Kingdom of Great Britain and Northern Ireland

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demonstrates that SSAs exert antiproliferative effects and inhibit tumour growth via the somatostatin receptor 2 (SSTR2). Direct antiproliferative effects occur through the activation of Src homology 2 domain phosphatase-1 and Src homology 2 domain phosphatase

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Nele F Lenders Department of Endocrinology, St Vincent’s Hospital, Sydney, NSW, Australia
Garvan Institute of Medical Research, Sydney, NSW, Australia
St Vincent’s Clinical School, University of New South Wales, Sydney, NSW, Australia

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Peter E Earls Department of Anatomical Pathology and Cytopathology, St Vincent’s Pathology, Sydney, NSW, Australia

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Warrick J Inder Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia

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Ann I McCormack Department of Endocrinology, St Vincent’s Hospital, Sydney, NSW, Australia
Garvan Institute of Medical Research, Sydney, NSW, Australia
St Vincent’s Clinical School, University of New South Wales, Sydney, NSW, Australia

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). Sparsely granulated somatotroph tumours have been associated with larger size, invasiveness, aryl hydrocarbon receptor-interacting protein (AIP) mutations, lower SSTR2 expression and poor response to somatostatin receptor ligands ( Brzana et al. 2013

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Dheeratama Siripongsatian National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand

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Quido G de Lussanet de la Sablonière Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands

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Frederik Anton Verburg Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands

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Tessa Brabander Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands

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C Waldeck K Kirby L Rogers BE Eu P Tothill RW & Hicks RJ 2020 Enhancing the anti-tumour activity of 177Lu-DOTA-octreotate radionuclide therapy in somatostatin receptor-2 expressing tumour models by targeting PARP . Scientific Reports

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Katherine A English OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK

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Rajesh V Thakker OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK

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Kate E Lines OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK

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acid receptor responder 1; RASSF1A, Ras association domain family member 1; REN, renin producing; SFRP1, secreted frizzled related protein 1; SOM, somatostatinoma; SSTR2, STK11, somatostatin receptor 2; serine/threonine kinase 11; TERT, telomerase

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