Management of Small Bowel Neuroendocrine Tumors
1
Endocrine Oncology Site Group, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G2C1, Canada
2
Division of Endocrinology and Metabolism, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada
3
Department of Medicine, Institute of Endocrinology, Beilinson Hospital, Petach Tikva 4941492, Israel
4
Department of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(9), 1395; https://doi.org/10.3390/cancers11091395
Received: 31 July 2019
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Revised: 8 September 2019
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Accepted: 15 September 2019
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Published: 18 September 2019
(This article belongs to the Special Issue Management of Neuroendocrine Neoplasms)
Several important landmark trials have reshaped the landscape of non-surgical management of small bowel neuroendocrine tumors over the last few years, with the confirmation of the antitumor effect of somatostatin analogue therapy in PROMID and CLARINET trials as well as the advent of therapies with significant potential such as mammalian target of rapamycin inhibitor (mTor) everolimus (RADIANT trials) and peptide receptor radionuclide therapy (PRRT) with 177-Lutetium (NETTER-1 trial). This narrative summarizes the recommended management strategies of small bowel neuroendocrine tumors. We review the main evidence behind each recommendation as well as compare and contrast four major guidelines, namely the 2016 Canadian Consensus guidelines, the 2017 North American Neuroendocrine Tumor Society guidelines, the 2018 National Comprehensive Cancer Network guidelines, and the 2016 European Neuroendocrine Tumor Society guidelines. Different clinical situations will be addressed, from loco-regional therapy to metastatic unresectable disease. Carcinoid syndrome, which is mostly managed by somatostatin analogue therapy and the serotonin antagonist telotristat etiprate for refractory diarrhea, as well as neuroendocrine carcinoma will be reviewed. However, several questions remain unanswered, such as the optimal management of neuroendocrine carcinomas or the effect of combining and sequencing of the aforementioned modalities where more randomized controlled trials are needed.
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Keywords:
small bowel; neuroendocrine tumor; carcinoid; carcinoid syndrome; neuroendocrine carcinoma; somatostatin analogue; everolimus; PRRT
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MDPI and ACS Style
Larouche, V.; Akirov, A.; Alshehri, S.; Ezzat, S. Management of Small Bowel Neuroendocrine Tumors. Cancers 2019, 11, 1395. https://doi.org/10.3390/cancers11091395
AMA Style
Larouche V, Akirov A, Alshehri S, Ezzat S. Management of Small Bowel Neuroendocrine Tumors. Cancers. 2019; 11(9):1395. https://doi.org/10.3390/cancers11091395
Chicago/Turabian StyleLarouche, Vincent, Amit Akirov, Sameerah Alshehri, and Shereen Ezzat. 2019. "Management of Small Bowel Neuroendocrine Tumors" Cancers 11, no. 9: 1395. https://doi.org/10.3390/cancers11091395
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