Selecting patients for cytotoxic therapies in gastroenteropancreatic neuroendocrine tumours

Pancreatic neuroendocrine tumors: Accurate grading with Ki‐67 index on fine‐needle aspiration specimens using the WHO 2010/ENETS criteria

“…Although localized panNETs are primarily treated with surgical resection, ablative and embolization techniques are typically used for the management of liver metastases . Tumor location, grade, stage, and proliferative index play a role in selecting the appropriate treatment regimens . Somatostatin analogues, chemotherapy, and targeted agents are the main pharmacological treatments available for patients with panNETs.…”

“…Somatostatin analogues, chemotherapy, and targeted agents are the main pharmacological treatments available for patients with panNETs. Clinical trials evaluating somatostatin analogues in conjunction with interferon‐α for patients with advanced disease and their application in grade 1 panNETs is currently ongoing . Chemotherapy modalities can be used in patients with unresectable tumors or as an adjunct therapy for tumor debulking; however, toxicity limits their use .…”

“…Clinical trials evaluating somatostatin analogues in conjunction with interferon‐α for patients with advanced disease and their application in grade 1 panNETs is currently ongoing . Chemotherapy modalities can be used in patients with unresectable tumors or as an adjunct therapy for tumor debulking; however, toxicity limits their use . Newer agents such as everolimus and sunitinib can be considered in patients with advanced grade 2 and grade 3 panNETs that are refractory to chemotherapy or as an alternative treatment to ablative therapy or chemotherapy .…”

Zollinger–Ellison syndrome

“…Recently, a number of guidelines became available covering antitumor treatment in patients with advanced, metastatic disease due to pNETs[6●●,12,13,122●●,123,124], as well as a number of recent reviews that cover all aspects of these treatments. These include reviews of use of cytoreductive surgery[6●●,122●●,125–127], chemotherapy[6,10,122●●,128,129], liver-directed therapies(embolization, chemoembolization, radioembolization, radio-frequency ablation)[6●●,122●●,125–127,130,131●], biotherapies(somatostatin analogues/interferon)[6●●,125,132●,133], liver transplantation[6●●,125,134], targeted-molecular therapies(mTOR(everolimus)/tyrosine-kinase receptors(sunitinib)[6●●,10,125,135●●,136●●,137], and peptide-radioreceptor-therapy(PRRT) using radiolabeled-somatostatin-analogues[6●●,138●]. Because this area is well covered in recent reviews and the findings/approaches are not specific for ZES, but used for all pNETs, this area will be only be briefly discussed.…”

Medical treatment of neuroendocrine tumours

“…Alacsony proliferációs index esetén kemoterápiától nem várhatunk érdemi daganatellenes hatást [30]. Kemoterápia javasolható, ha 1. a szomatosztatinanalóg, illetve interferonkezelés (már) nem eredményes, 2. a daganat gyorsan növekszik, 3. nagy a tumortömeg, és a beteg ezzel össze-függésbe hozhatóan panaszos, 4. a klinikai jelek rossz prognózist sugallnak (csont-, illetve egyéb extrahepaticus áttétek mutathatók ki) [9,12,31,32], továbbá, ha 5. a Ki-67-index >10% [33].…”