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Medical Treatment of Gastroenteropancreatic Neuroendocrine Tumors
Department of Gastroenterology, University Hospital Marburg, Baldinger Strasse, Marburg D-35043, Germany
* Author to whom correspondence should be addressed.
Received: 1 December 2011; in revised form: 23 January 2012 / Accepted: 30 January 2012 / Published: 8 February 2012
Abstract: Treatment of the clinically and prognostically heterogeneous neuroendocrine neoplasms (NEN) should be based on a multidisciplinary approach, including surgical, interventional, medical and nuclear medicine-based therapeutic options. Medical therapies include somatostatin analogues, interferon-a, mTOR inhibitors, multikinase inhibitors and systemic chemotherapy. For the selection of the appropriate medical treatment the hormonal activity, primary tumor localization, tumor grading and growth behaviour as well as the extent of the disease must be considered. Somatostatin analogues are mainly indicated in hormonally active tumors for symptomatic relief, but antiproliferative effects have also been demonstrated, especially in well-differentiated intestinal NET. The efficacy of everolimus and sunitinib in patients with pancreatic neuroendocrine tumors (pNET) has been demonstrated in large placebo-controlled clinical trials. pNETs are also chemosensitive. Streptozocin-based chemotherapeutic regimens are regarded as current standard of care. Temozolomide in combination with capecitabine is an alternative that has shown promising results that need to be confirmed in larger trials. Currently, no comparative studies and no molecular markers are established that predict the response to medical treatment. Therefore the choice of treatment for each pNET patient is based on individual parameters taking into account the patient’s preference, expected side effects and established response criteria such as proliferation rate and tumor load. Platin-based chemotherapy is still the standard treatment for poorly differentiated neuroendocrine carcinomas. Clearly, there is an unmet need for new systemic treatment options in patients with extrapancreatic neuroendocrine tumors.
Keywords: neuroendocrine tumor; neuroendocrine carcinoma; somatostatin analogues; interferon-a; mTOR inhibitor; multikinase inhibitor; chemotherapy
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Rinke, A.; Michl, P.; Gress, T. Medical Treatment of Gastroenteropancreatic Neuroendocrine Tumors. Cancers 2012, 4, 113-129.
Rinke A, Michl P, Gress T. Medical Treatment of Gastroenteropancreatic Neuroendocrine Tumors. Cancers. 2012; 4(1):113-129.
Rinke, Anja; Michl, Patrick; Gress, Thomas. 2012. "Medical Treatment of Gastroenteropancreatic Neuroendocrine Tumors." Cancers 4, no. 1: 113-129.