New therapeutic approaches to metastatic gastroenteropancreatic neuroendocrine tumors: A glimpse into the future

Abstract

Neuroendocrine (NE) gastroenteropancreatic tumors are a heterogeneous group of neoplasias arising from neuroendocrine cells of the embryological gut. Their incidence have increased significantly over the past 3 decades probably due to the improvements in imaging and diagnosis. The recent advances in molecular biology have translated into an expansion of therapeutic approaches to these patients. Somatostatin analogs, which initially were approved for control of hormonal syndromes, have recently been proven to inhibit tumor growth. Several new drugs such as antiangiogenics and others targeting mammalian target of rapamycin pathways have been approved to treat progressive pancreatic neuroendocrine tumors (NETs) although their role in non-pancreatic is still controversial. The treatment of NETs requires a coordinated multidisciplinary approach. The management of localized NETs primarily involves surgical resection followed by surveillance. However, the treatment of unresectable and/or metastatic disease may involve a combination of surgical resection, systemic therapy, and liver-directed therapies with the goal of alleviating symptoms of peptide release and controlling tumor growth. This article will review the current therapeutic strategies for metastatic gastroenteropancreatic NETs and will take a glimpse into the future approaches.

Somatostatin Receptor Expression Is Associated With Metastasis and Patient Outcome in Pulmonary Carcinoid Tumors

“…Nevertheless, in both the European Neuroendocrine Tumor Society (26,27) and the North American Neuroendocrine Tumor Society (28,29) consensus guidelines for diagnosing and treating PC patients, somatostatin analogs are mentioned as a treatment option. According to recent findings, SSAs are not only involved in the control of hormonal syndromes, but they also have a role as antiproliferative agents in neuroendocrine tumors (9,30). Benefit of the SSA treatment with octreotide, lanreotide or 177 Lu-DOTATATE for patients with metastatic pulmonary carcinoid tumor has been shown by multiple studies and was also confirmed in our study (31)(32)(33)(34)(35).…”

Liver transplantation for unresectable pancreatic neuroendocrine tumors with liver metastases in an era of transplant oncology

“…Pancreatic neuroendocrine tumors (pNETs) represent approximately 7% of all NETs. Their prevalence has considerably increased over the last three decades, which is primarily due to improvements in imaging and diagnostic techniques (1,2). Despite the increased diagnosis of incidental lesions, 40-95% of patients present with a metastatic disease at the first diagnosis (2,3).…”

Treatment Patterns and Survival among Patients with Metastatic Gastroenteropancreatic Neuroendocrine Tumours in Sweden - a Population-based Register-linkage and Medical Chart Review Study

“…Other treatments for GEP-NET include molecular targeted therapy, chemotherapy and peptide receptor radionuclide therapy (PRRT). For liver metastases, surgical resection, hepatic artery embolization (HAE), selective internal radiation therapy (SIRT) and radiofrequency ablation (RFA) or microwave ablation (MWA) can be performed [4][5][6].…”