Reviews in Endocrine and Metabolic Disorders

, Volume 18, Issue 4, pp 485–497 | Cite as

Chemotherapy in NETs: When and how

  • Anna Angelousi
  • Gregory Kaltsas
  • Anna Koumarianou
  • Martin O. Weickert
  • Ashley Grossman


The majority of neuroendocrine tumours (NETs) are well-differentiated tumours that follow an indolent course, in contrast to a minority of poorly differentiated neuroendocrine carcinomas (NECs) which exhibit an aggressive course and assocaited with an overall short survival. Although surgery is the only curative treatment for NETs it is not always feasible,necessitating the application of other therapies including chemotherapy. Streptozotocin (STZ)-based regimens have long been used for advanced or metastatic well-to-moderately differentiated (G1-G2) NETs, especially those originating from the pancreas (pNETs). In poorly differentiated grade 3 (G3) tumours, platinum-based chemotherapy is recommended as first-line therapy, albeit without durable responses. Although data for temozolomide (TMZ)-based chemotherapy are still evolving, this treatment may replace STZ-based regimens in pNETs due to its better tolerability and side effect profile. In addition, there is evidence that TMZ could also be used in the subgroup of well-differentiated G3 NETs. There is less clear-cut evidence of a benefit for chemotherapy in intestinal NETs, but still evolving data suggest that TMZ may be efficacious in particular patients. In lung and thymic carcinoids, chemotherapy is reserved for patients with progressive metastatic disease in whom other treatment options are unavailable. Overall, chemotherapy is indicated in patients who have progressed on first-line treatment with somatostatin analogues, have extensive tumour load or exhibit rapid growth following a period of follow-up, and/or have a high proliferative rate; it may occasionally can be used in a neo-adjuvant setting. Prospective randomised studies are awaited to substantiate the role of chemotherapy in the therapeutic algorithm of NETs along with other evolving treatments.


Neuroendocrine tumours Neuroendocrine cancer Chemotherapy Temozolomide Radiopeptides 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Anna Angelousi
    • 1
  • Gregory Kaltsas
    • 1
    • 2
  • Anna Koumarianou
    • 3
  • Martin O. Weickert
    • 2
  • Ashley Grossman
    • 4
  1. 1.Department of Pathophysiology, Endocrine Oncology UnitLaiko Hospital, National and Kapodistrian University of AthensAthensGreece
  2. 2.Department of EndocrinologyUniversity of Warwick Medical SchoolCoventryUK
  3. 3.Hematology- Oncology Unit, Fourth Department of Internal MedicineNational and Kapodistrian University of Athens, Medical School, Attikon HospitalAthensGreece
  4. 4.Neuroendocrine Tumour CentreRoyal Free HospitalLondonUK

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