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Treatment of Pancreatic Neuroendocrine Tumors

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Neuroendocrine Neoplasia Management

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Abstract

About 40–80% of patients with pancreatic neuroendocrine tumors (PNETs) are metastatic at presentation, usually involving the liver. Here we will provide an up-to-date review of treatment options for patients with metastatic PanNETs. If patients are not suitable for surgery with curative intent, a medical management of disease is need. The availability of different treatment options require personalized therapeutic approach according to the features of individual patients and tumors. Watch and wait strategy is an option just for a limited number of patients with a low burden, asymptomatic and not progressing disease. For well-differentiated (G1–2) and SSTR-positive PanNETs, the treatment of choice is somatostatin analogs (SSTAs) that are effective and well tolerated. After SSTA failure, target therapies (everolimus and sunitinib), chemotherapy, and peptide receptor radionuclide therapy (PRRT) are all adequately supported by strong scientific data, and there are no clear criteria that favor the choice of one treatment over the other. The decision-making process should be conducted as part of a multidisciplinary tumor board and must be based on some key elements: the Grade (G 1,2,3), the proliferation index (Ki67), expression of somatostatin receptors, the rate of growth of the disease over time, and the presence of tumor-related symptoms. Finally in poorly differentiated carcinoma (PanNEC), platinum-based chemotherapy is the only available treatment option although the results in terms of overall survival are disappointing.

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Authors and Affiliations

  1. Oncology Unit, Humanitas Istituto Clinico Catanese, Misterbianco, Italy

    Carlo Carnaghi

  2. Gastroenterology and Digestive Endoscopy Unit, Ospedale Santa Chiara, Trento, Italy

    Elettra Merola

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  1. Carlo Carnaghi
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  2. Elettra Merola
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Correspondence to Carlo Carnaghi .

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Editors and Affiliations

  1. Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy

    Giordano Beretta

  2. ASST-Spedali Civili, University of Brescia, BRESCIA, Brescia, Italy

    Alfredo Berruti

  3. Nuclear Medicine, Humanitas Gavazzeni, BERGAMO, Bergamo, Italy

    Emilio Bombardieri

  4. GIT Med Oncology & Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy

    Nicola Fazio

  5. General Surgery Unit, Humanitas Gavazzeni, Bergamo, Italy

    Orlando Goletti

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Carnaghi, C., Merola, E. (2021). Treatment of Pancreatic Neuroendocrine Tumors. In: Beretta, G., Berruti, A., Bombardieri, E., Fazio, N., Goletti, O. (eds) Neuroendocrine Neoplasia Management. Springer, Cham. https://doi.org/10.1007/978-3-030-72830-4_14

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