- Review
An Update on Novel Pharmacotherapies for the Treatment of Neuroendocrine Tumors
- Khalil Choucair,
- Roupen Odabashian and
- Sushmita Nanja Reddy
- + 2 authors
Neuroendocrine tumors (NETs) are heterogeneous neoplasms with different molecular characteristics and prognosis. Although slow-growing, NETs are often diagnosed at an advanced stage. The treatment choice depends on primary site, extent, grade, growth rate, somatostatin receptor status, functional status, performance status, and comorbidities. Precise knowledge of the biological and molecular features of NETs has led to the development of novel therapies. Therapeutic options include somatostatin analogs, multi-targeted tyrosine kinase inhibitors (e.g., sunitinib), or mammalian targets of rapamycin (mTOR) inhibitors (e.g., everolimus), telotristat ethyl, chemotherapy, and peptide-receptor radionuclide therapy. Pivotal studies that led to approval, treatment-related adverse events, and safety concerns, as demonstrated in clinical trials and real-world clinical practice. Questions, such as the optimal timing, selection, and sequence of therapies, and biomarkers that predict response to the novel agents in an individual patient, remain to be answered. We propose a stepwise approach for the management of advanced Gastro-entero-pancreatic (GEP)-NETs that utilizes a multidisciplinary team of experts. Biomarkers may assist in both the diagnosis and post-treatment follow-up in patients with GEP-NETs. The next decade of research on GEP-NETs is promising and should provide new insights into the molecular underpinnings of this disease, therapy selection, and the sequencing of the available therapies, along with the potential role of AL in NET pharmacotherapy.
16 November 2025





![Signaling pathways involved in GEP-NET growth and tumor development. VEGFR: vascular endothelial growth factor receptor; EGFR: epidermal growth factor receptor; BRAF: B-Raf Proto-oncogene; MAPK: mitogen-activated protein kinase; miR: micro RNA; ERK: extra-cellular signal-regulated kinase; EWSR1: EWS RNA binding protein 1; IGF-1R: insulin-like growth factor receptor 1; FGFR3: fibroblast growth factor receptor 3; PI3K: phosphatidylinositol-3-kinase; AKT: protein kinase B: TSC1/2: Tuberous sclerosis 1; mTOR; mammalian target of rapamycin; S6K: 4-EBP1 Eukaryotic translation initiation factor 4E-binding protein 1; DAXX: death domain-associated protein; ATRX: X-linked mental retardation and alpha-thalassemia syndrome protein; ATM: ataxia telangiectasia; SSTR: somatostatin receptor; PTEN: phosphatase and tensin homolog deleted; PLC: phospholipase C; SHP1: Src homology region 2 domain-containing phosphatase-1; HIF1: hypoxia-inducible factor 1; VHL. Von Hippel-Lindau. Adapted from [54].](/_ipx/b_%23fff&f_webp&q_100&fit_outside&s_470x317/https://mdpi-res.com/ijms/ijms-26-11095/article_deploy/html/images/ijms-26-11095-g001-550.jpg)

