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Update in the Therapy of Advanced Neuroendocrine Tumors

  • Upper Gastrointestinal Cancers (L Rajdev, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Neuroendocrine tumors (NETs) are rare neoplasms, with an estimated annual incidence of ~ 6.9/100,000. NETs arise throughout the body from cells of the diffuse endocrine system. More than half originate from endocrine cells of the gastrointestinal tract and the pancreas, thus being referred to as gastroenteropancreatic NETs (GEP-NETs). The only treatment that offers a cure is surgery; however, most patients are diagnosed with metastatic disease, and curative surgery is usually not an option. These patients can be offered long-term systemic treatment, for both symptomatic relief and tumor growth suppression. Evidence-based treatment options include somatostatin analogs, everolimus (a mTOR inhibitor), sunitinib (a tyrosine kinase inhibitor), and peptide receptor radionuclide therapy, alone or combined with cytoreductive procedures (surgery or liver-directed procedures). Other treatment options being investigated are immunotherapy and epigenetic assessment that may lead to more personalized interventions. We believe that each patient should be thoroughly evaluated and their case discussed by a multidisciplinary team that is up-to-date with all treatment modalities including ongoing clinical trials, before selecting the proper treatment option.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017.

  2. Grozinsky-Glasberg S, Grossman AB, Korbonits M. The role of somatostatin analogues in the treatment of neuroendocrine tumours. Mol Cell Endocrinol. 2008;286(1–2):238–50.

    Article  CAS  PubMed  Google Scholar 

  3. Kim JY, Hong SM. Recent updates on neuroendocrine tumors from the gastrointestinal and pancreatobiliary tracts. Arch Pathol Lab Med. 2016;140(5):437–48.

    Article  PubMed  Google Scholar 

  4. Raj N, Reidy-Lagunes D. Systemic therapies for advanced pancreatic neuroendocrine tumors. Hematol Oncol Clin North Am. 2016;30(1):119–33.

    Article  PubMed  Google Scholar 

  5. Bousquet C, Lasfargues C, Chalabi M, Billah SM, Susini C, Vezzosi D, et al. Clinical review: current scientific rationale for the use of somatostatin analogs and mTOR inhibitors in neuroendocrine tumor therapy. J Clin Endocrinol Metab. 2012;97(3):727–37.

    Article  CAS  PubMed  Google Scholar 

  6. Oberg KE, Reubi JC, Kwekkeboom DJ, Krenning EP. Role of somatostatins in gastroenteropancreatic neuroendocrine tumor development and therapy. Gastroenterology. 2010;139(3):742–53. 53.e1

    Article  PubMed  Google Scholar 

  7. Alonso-Gordoa T, Capdevila J, Grande E. GEP-NETs update: biotherapy for neuroendocrine tumours. Eur J Endocrinol. 2015;172(1):R31–46.

    Article  CAS  PubMed  Google Scholar 

  8. Chan JA, Kulke MH. Progress in the treatment of neuroendocrine tumors. Curr Oncol Rep. 2009;11(3):193–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Rinke A, Muller HH, Schade-Brittinger C, Klose KJ, Barth P, Wied M, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID study group. J Clin Oncol. 2009;27(28):4656–63.

    Article  CAS  PubMed  Google Scholar 

  10. Caplin ME, Pavel M, Cwikla JB, Phan AT, Raderer M, Sedlackova E, et al. Lanreotide in metastatic enteropancreatic neuroendocrine tumors. N Engl J Med. 2014;371(3):224–33.

    Article  PubMed  Google Scholar 

  11. Rinke A, Wittenberg M, Schade-Brittinger C, Aminossadati B, Ronicke E, Gress TM, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors (PROMID): results of long-term survival. Neuroendocrinology. 2017;104(1):26–32.

    Article  CAS  PubMed  Google Scholar 

  12. Caplin ME, Pavel M, Cwikla JB, Phan AT, Raderer M, Sedlackova E, et al. Anti-tumour effects of lanreotide for pancreatic and intestinal neuroendocrine tumours: the CLARINET open-label extension study. Endocr Relat Cancer. 2016;23(3):191–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Pavel M, Valle JW, Eriksson B, Rinke A, Caplin M, Chen J, et al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: systemic therapy—biotherapy and novel targeted agents. Neuroendocrinology. 2017;

  14. Wolin EM, Jarzab B, Eriksson B, Walter T, Toumpanakis C, Morse MA, et al. Phase III study of pasireotide long-acting release in patients with metastatic neuroendocrine tumors and carcinoid symptoms refractory to available somatostatin analogues. Drug Design Dev Ther. 2015;9:5075–86.

    Article  Google Scholar 

  15. Oberg K, Norheim I, Lind E, Alm G, Lundqvist G, Wide L, et al. Treatment of malignant carcinoid tumors with human leukocyte interferon: long-term results. Cancer Treat Reps. 1986;70(11):1297–304.

    CAS  Google Scholar 

  16. Oberg K. Biotherapies for GEP-NETs. Best Pract Res Clin Gastroenterol. 2012;26(6):833–41.

    Article  PubMed  Google Scholar 

  17. •• Pavel M, Horsch D, Caplin M, Ramage J, Seufferlein T, Valle J, et al. Telotristat etiprate for carcinoid syndrome: a single-arm, multicenter trial. J Clin Endocrinol Metab. 2015;100(4):1511–9. A prospective, exploratory, dose-escalating 12-week, open-label, multicenter study, evaluating the clinical and biochemical efficacy, and safety of telotristat in patients with metastatic, well-differentiated NETs.

    Article  CAS  PubMed  Google Scholar 

  18. Kulke MH, O'Dorisio T, Phan A, Bergsland E, Law L, Banks P, et al. Telotristat etiprate, a novel serotonin synthesis inhibitor, in patients with carcinoid syndrome and diarrhea not adequately controlled by octreotide. Endocr Relat Cancer. 2014;21(5):705–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. •• Kulke MH, Horsch D, Caplin ME, Anthony LB, Bergsland E, Oberg K, et al. Telotristat ethyl, a tryptophan hydroxylase inhibitor for the treatment of carcinoid syndrome. J Clin Oncol. 2017;35(1):14–23. A placebo-controlled phase III study, evaluating telotristat effect on bowel movements and 5HIAA levels, in patients with carcinoid syndrome not well controlled by SSA.

    Article  PubMed  Google Scholar 

  20. Chan J, Kulke M. Targeting the mTOR signaling pathway in neuroendocrine tumors. Curr Treat Options in Oncol. 2014;15(3):365–79.

    Article  Google Scholar 

  21. Svejda B, Kidd M, Kazberouk A, Lawrence B, Pfragner R, Modlin IM. Limitations in small intestinal neuroendocrine tumor therapy by mTOR kinase inhibition reflect growth factor-mediated PI3K feedback loop activation via ERK1/2 and AKT. Cancer. 2011;117(18):4141–54.

    Article  CAS  PubMed  Google Scholar 

  22. Yao JC, Phan AT, Chang DZ, Wolff RA, Hess K, Gupta S, et al. Efficacy of RAD001 (everolimus) and octreotide LAR in advanced low- to intermediate-grade neuroendocrine tumors: results of a phase II study. J Clin Oncol. 2008;26(26):4311–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pavel ME, Hainsworth JD, Baudin E, Peeters M, Horsch D, Winkler RE, et al. Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study. Lancet (London, England). 2011;378(9808):2005–12.

    Article  CAS  Google Scholar 

  24. Yao JC, Shah MH, Ito T, Bohas CL, Wolin EM, Van Cutsem E, et al. Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med. 2011;364(6):514–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. • Yao JC, Fazio N, Singh S, Buzzoni R, Carnaghi C, Wolin E, et al. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. Lancet (London, England). 2016;387(10022):968–77. A randomised, double-blind, placebo-controlled, phase 3 study, evaluating the efficacy and safety of everolimus compared with placebo, in patients with advanced, progressive, well-differentiated, non-functional NETs of lung or GIT.

    Article  CAS  Google Scholar 

  26. Lombard-Bohas C, Yao JC, Hobday T, Van Cutsem E, Wolin EM, Panneerselvam A, et al. Impact of prior chemotherapy use on the efficacy of everolimus in patients with advanced pancreatic neuroendocrine tumors: a subgroup analysis of the phase III RADIANT-3 trial. Pancreas. 2015;44(2):181–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Freitag H, Christen F, Lewens F, Grass I, Briest F, Iwaszkiewicz S, et al. Inhibition of mTOR’s catalytic site by PKI-587 is a promising therapeutic option for gastroenteropancreatic neuroendocrine tumor disease. Neuroendocrinology. 2017;105:90–104.

    Article  CAS  PubMed  Google Scholar 

  28. Vandamme T, Beyens M, Op de Beek K, Dogan F, van Koetsveld MP, Pauwels P, et al. Long-term acquired everolimus resistance in pancreatic neuroendocrine tumours can be overcome with novel PI3K-AKT-mTOR inhibitors. Br J Cancer. 2016;114:650–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Raymond E, Hobday T, Castellano D, Reidy-Lagunes D, Garcia-Carbonero R, Carrato A. Therapy innovations: tyrosine kinase inhibitors for the treatment of pancreatic neuroendocrine tumors. Cancer Metastasis Rev. 2011;30(Suppl 1):19–26.

    Article  CAS  PubMed  Google Scholar 

  30. Capozzi M, Von Arx C, De Divitiis C, Ottaiano A, Tatangelo F, Romano GM, et al. Antiangiogenic therapy in pancreatic neuroendocrine tumors. Anticancer Res. 2016;36(10):5025–30.

    Article  PubMed  Google Scholar 

  31. Raymond E, Dahan L, Raoul JL, Bang YJ, Borbath I, Lombard-Bohas C, et al. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med. 2011;364(6):501–13.

    Article  CAS  PubMed  Google Scholar 

  32. Phan AT, Halperin DM, Chan JA, Fogelman DR, Hess KR, Malinowski P, et al. Pazopanib and depot octreotide in advanced, well-differentiated neuroendocrine tumours: a multicentre, single-group, phase 2 study. Lancet Oncol. 2015;16(6):695–703.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Strosberg JR, Cives M, Hwang J, Weber T, Nickerson M, Atreya CE, et al. A phase II study of axitinib in advanced neuroendocrine tumors. Endocr Relat Cancer. 2016;23(5):411–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Abdel-Rahman O, Fouad M. Bevacizumab-based combination therapy for advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs): a systematic review of the literature. J Cancer Res Clin Oncol. 2015;141(2):295–305.

    Article  CAS  PubMed  Google Scholar 

  35. Berruti A, Fazio N, Ferrero A, Brizzi MP, Volante M, Nobili E, et al. Bevacizumab plus octreotide and metronomic capecitabine in patients with metastatic well-to-moderately differentiated neuroendocrine tumors: the XELBEVOCT study. BMC Cancer. 2014;14:184.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Mitry E, Walter T, Baudin E, Kurtz JE, Ruszniewski P, Dominguez-Tinajero S, et al. Bevacizumab plus capecitabine in patients with progressive advanced well-differentiated neuroendocrine tumors of the gastro-intestinal (GI-NETs) tract (BETTER trial)—a phase II non-randomised trial. Eur J Cancer. 2014;50:3107–15.

    Article  CAS  PubMed  Google Scholar 

  37. Chan JA, Stuart K, Earle CC, Clark JW, Bhargava P, Miksad R, et al. Prospective study of bevacizumab plus temozolomide in patients with advanced neuroendocrine tumors. J Clin Oncol. 2012;30(24):2963–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Kunz PL, Balise RR, Fehrenbacher L, Pan M, Venook AP, Fisher GA, et al. Oxaliplatin-fluoropyrimidine chemotherapy plus bevacizumab in advanced neuroendocrine tumors: an analysis of 2 phase II trials. Pancreas. 2016;45(10):1394–400.

    Article  CAS  PubMed  Google Scholar 

  39. Yao JC, Phan AT, Hess K, Fogelman D, Jacobs C, Dagohoy C, et al. Perfusion computed tomography as functional biomarker in randomized run-in study of bevacizumab and everolimus in well-differentiated neuroendocrine tumors. Pancreas. 2015;44(2):190–7.

    Article  CAS  PubMed  Google Scholar 

  40. Hobday TJ, Qin R, Reidy-Lagunes D, Moore MJ, Strosberg J, Kaubisch A, et al. Multicenter phase II trial of temsirolimus and bevacizumab in pancreatic neuroendocrine tumors. J Clin Oncol. 2015;33:1551–6.

    Article  CAS  PubMed  Google Scholar 

  41. Yao JC, Guthrie KA, Moran C, Strosberg JR, Kulke MH, Chan JA, et al. Phase III prospective randomized comparison trial of depot octreotide plus interferon alfa-2b versus depot octreotide plus bevacizumab in patients with advanced carcinoid tumors: SWOG S0518. J Clin Oncol. 2017;35(15):1695–703.

    Article  PubMed  Google Scholar 

  42. Kulke M, Niedzwiecki D, Foster N, Fruth B, Kunz P, Kennecke H, et al. Randomized phase II study of everolimus (E) versus everolimus plus bevacizumab (E+B) in patients (Pts) with locally advanced or metastatic pancreatic neuroendocrine tumors (pNET), CALGB 80701 (alliance). J Clin Oncol. 2015;33 (Supplement) abstract 4005.

  43. Bergsma H, van Vliet EI, Teunissen JJ, Kam BL, de Herder WW, Peeters RP, et al. Peptide receptor radionuclide therapy (PRRT) for GEP-NETs. Best Pract Res Clin Gastroenterol. 2012;26(6):867–81.

    Article  CAS  PubMed  Google Scholar 

  44. Brabander T, Teunissen JJ, Van Eijck CH, Franssen GJ, Feelders RA, de Herder WW, et al. Peptide receptor radionuclide therapy of neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab. 2016;30(1):103–14.

    Article  CAS  PubMed  Google Scholar 

  45. Cives M, Strosberg J. Radionuclide therapy for neuroendocrine tumors. Curr Oncol Rep. 2017;19(2):9.

    Article  PubMed  Google Scholar 

  46. •• Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, et al. Phase 3 trial of 177Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376(2):125–35. A randomized, controlled trial, evaluating the efficacy and safety of lutetium-177 (177Lu)-Dotatate in patients with advanced midgut NETs, who progressed under SSA treatment.

    Article  CAS  PubMed  Google Scholar 

  47. Kwekkeboom DJ, Krenning EP. Peptide receptor radionuclide therapy in the treatment of neuroendocrine tumors. Hematol Oncol Clin North Am. 2016;30(1):179–91.

    Article  PubMed  Google Scholar 

  48. Dilz LM, Denecke T, Steffen IG, Prasad V, von Weikersthal LF, Pape UF, et al. Streptozocin/5-fluorouracil chemotherapy is associated with durable response in patients with advanced pancreatic neuroendocrine tumours. Eur J Cancer (Oxford, England : 1990). 2015;51(10):1253–62.

    Article  CAS  Google Scholar 

  49. Okusaka T, Ueno H, Morizane C, Kondo S, Sakamoto Y, Takahashi H, et al. Cytotoxic chemotherapy for pancreatic neuroendocrine tumors. J Hepato-Biliary-Pancreatic Sci. 2015;22(8):628–33.

    Article  Google Scholar 

  50. • Koumarianou A, Kaltsas G, Kulke MH, Oberg K, Strosberg JR, Spada F, et al. Temozolomide in advanced neuroendocrine neoplasms: pharmacological and clinical aspects. Neuroendocrinology. 2015;101(4):274–88. A literature review regarding pharmacological and clinical aspects of TMZ, focusing on specific settings of NENs, different schedules, toxicity and safety profiles, and potential predictive biomarkers of response.

    Article  CAS  PubMed  Google Scholar 

  51. Ekeblad S, Sundin A, Janson, Welin S, Granberg D, Kindmark H, et al. Temozolomide as monotherapy is effective in treatment of advanced malignant neuroendocrine tumors. Clin Can Res. 2007;13(10):2986–91.

  52. Strosberg JR, Fine RL, Choi J, Nasir A, Coppola D, Chen DT, et al. First-line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas. Cancer. 2011;117(2):268–75.

    Article  CAS  PubMed  Google Scholar 

  53. Fine RL, Gulati AP, Krantz BA, Moss RA, Schreibman S, Tsushima DA, et al. Capecitabine and temozolomide (CAPTEM) for metastatic, well-differentiated neuroendocrine cancers: The Pancreas Center at Columbia University experience. Cancer Chemother Pharmacol. 2013;71(3):663–70.

    Article  CAS  PubMed  Google Scholar 

  54. Fine RL, Gulati AP, Tsushima D, Mowatt KB, Oprescu A, Bruce JN, et al. Prospective phase II study of capecitabine and temozolomide (CAPTEM) for progressive, moderately, and well-differentiated metastatic neuroendocrine tumors. J Clin Oncol. 2014;32(3_suppl):179.

    Article  Google Scholar 

  55. Sbiera S, Wortmann S, Fassnacht M. Dendritic cell based immunotherapy—a promising therapeutic approach for endocrine malignancies. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 2008;40(2):89–98.

    Article  CAS  PubMed  Google Scholar 

  56. Datta J, Berk E, Cintolo JA, Xu S, Roses RE, Czerniecki BJ. Rationale for a multimodality strategy to enhance the efficacy of dendritic cell-based cancer immunotherapy. Front Immunol. 2015;6:271.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Patnaik A, Kang SP, Rasco D, Papadopoulos KP, Elassaiss-Schaap J, Beeram M, et al. Phase I study of pembrolizumab (MK-3475; anti-PD-1 monoclonal antibody) in patients with advanced solid tumors. Clin Can Res. 2015;21(19):4286–93.

    Article  CAS  Google Scholar 

  58. Pavel ME, Sers C. Women in cancer thematic review: systemic therapies in neuroendocrine tumors and novel approaches toward personalized medicine. Endocr Relat Cancer. 2016;23(11):T135–t54.

    Article  PubMed  Google Scholar 

  59. Leja J, Yu D, Nilsson B, Gedda L, Zieba A, Hakkarainen T, et al. Oncolytic adenovirus modified with somatostatin motifs for selective infection of neuroendocrine tumor cells. Gene Ther. 2011;18(11):1052–62.

    Article  CAS  PubMed  Google Scholar 

  60. Zappa M, Abdel-Rehim M, Hentic O, Vullierme MP, Ruszniewski P, Vilgrain V. Liver-directed therapies in liver metastases from neuroendocrine tumors of the gastrointestinal tract. Target Oncol. 2012;7(2):107–16.

    Article  PubMed  Google Scholar 

  61. Kress O, Wagner HJ, Wied M, Klose KJ, Arnold R, Alfke H. Transarterial chemoembolization of advanced liver metastases of neuroendocrine tumors—a retrospective single-center analysis. Digestion. 2003;68(2–3):94–101.

    Article  CAS  PubMed  Google Scholar 

  62. Carrasco CH, Charnsangavej C, Ajani J, Samaan NA, Richli W, Wallace S. The carcinoid syndrome: palliation by hepatic artery embolization. AJR Am J Roentgenol. 1986;147(1):149–54.

    Article  CAS  PubMed  Google Scholar 

  63. Granberg D, Eriksson LG, Welin S, Kindmark H, Janson, Skogseid B, et al. Liver embolization with trisacryl gelatin microspheres (embosphere) in patients with neuroendocrine tumors. Acta radiologica (Stockholm, Sweden : 1987). 2007;48(2):180–5.

  64. Therasse E, Breittmayer F, Roche A, De Baere T, Indushekar S, Ducreux M, et al. Transcatheter chemoembolization of progressive carcinoid liver metastasis. Radiology. 1993;189(2):541–7.

    Article  CAS  PubMed  Google Scholar 

  65. Kennedy AS, Dezarn WA, McNeillie P, Coldwell D, Nutting C, Carter D, et al. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol. 2008;31(3):271–9.

    Article  PubMed  Google Scholar 

  66. Mayo SC, Herman JM, Cosgrove D, Bhagat N, Kamel I, Geschwind JF, et al. Emerging approaches in the management of patients with neuroendocrine liver metastasis: role of liver-directed and systemic therapies. J Am Coll Surg. 2013;216(1):123–34.

    Article  PubMed  Google Scholar 

  67. Mayo SC, de Jong MC, Bloomston M, Pulitano C, Clary BM, Reddy SK, et al. Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: a multicenter international analysis. Ann Surg Oncol. 2011;18(13):3657–65.

    Article  PubMed  Google Scholar 

  68. Grandhi MS, Lafaro KJ, Pawlik TM. Role of locoregional and systemic approaches for the treatment of patients with metastatic neuroendocrine tumors. J Gastrointest Surg. 2015;19(12):2273–82.

    Article  PubMed  Google Scholar 

  69. Mazzaferro V, Pulvirenti A, Coppa J. Neuroendocrine tumors metastatic to the liver: how to select patients for liver transplantation? J Hepatol. 2007;47(4):460–6.

    Article  PubMed  Google Scholar 

  70. Stalberg P, Westin G, Thirlwell C. Genetics and epigenetics in small intestinal neuroendocrine tumours. J Intern Med. 2016;280(6):584–94.

    Article  CAS  PubMed  Google Scholar 

  71. Cives M, Simone V, Rizzo FM, Silvestris F. NETs: organ-related epigenetic derangements and potential clinical applications. Oncotarget. 2016;7(35):57414–29.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Grozinskey-Glasberg G, Gross DJ, et al. New drugs in the therapy of neuroendocrine tumors. J Endocrinol Investig. 2012;35(10):930–6.

    Google Scholar 

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Correspondence to Simona Grozinsky-Glasberg MD.

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Uri, I., Avniel-Polak, S., Gross, D.J. et al. Update in the Therapy of Advanced Neuroendocrine Tumors. Curr. Treat. Options in Oncol. 18, 72 (2017). https://doi.org/10.1007/s11864-017-0514-9

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