Treatment of gastroenteropancreatic neuroendocrine tumors

Abstract

Neuroendocrine tumors are rare; thus, individual experience with the diagnosis and treatment of these tumors is mostly low, except in specialized centers. For histological diagnosis, standards have been described recently. Pathological classification and clinical staging influence diagnostic and therapeutic decisions. This chapter aims at demonstrating the importance of pathological and clinical classification of neuroendocrine tumors on therapeutic decisions, indicating the appropriate therapy for different stages of the disease. Surgical therapy will be discussed shortly, including palliative surgical strategies. However, the focus of the manuscript is medical therapy. Biotherapy, its effects, and remaining uncertainties are presented as well as different chemotherapeutic schemes. Finally, new options of palliative medical therapies like kinase inhibitors and anti-angiogenetic drugs will be discussed.

mTOR expression and activity patterns in gastroenteropancreatic neuroendocrine tumours

“…Follow-up data were available for almost all patients. However, since NET-related death occurred in the minority of patients with low-stage and low-grade tumours and since NETs of different locations are known to have significantly different survival (Plöckinger & Wiedenmann 2007), we decided to perform survival analysis exclusively in the homogenous group of midgut patients with stage IV disease. In this subgroup of 39 patients for whom data were available, 8 (20.5%) died of their disease after a mean follow-up time of 78.0 months.…”

“…However, it is worth noting that the incidence of these tumours has risen tremendously over the last decades (Modlin et al 2003, Yao et al 2008a. Today, GEP-NET are treated in multidisciplinary approaches including surgery, biotherapy, chemotherapy as well as molecular targeted therapy (Plöckinger & Wiedenmann 2007, Oberg & Jelic 2008. Unfortunately, all improvements in the understanding and treatment of this disease have not resulted in significantly prolonged overall patient survival (Modlin et al 2008), therefore novel treatment strategies for these tumours are still urgently needed.…”

Salvage Therapy with 177Lu-Octreotate in Patients with Bronchial and Gastroenteropancreatic Neuroendocrine Tumors

“…Biotherapy with somatostatin analogs or interferon can result in an improvement of symptoms caused by an excess of bioactive substances, but tumor size reduction rarely occurs (2)(3)(4). Chemotherapy with various regimens can result in tumor shrinkage, but the median time to progression (TTP) is usually shorter than 18 mo (5,6). Moreover, such therapies can have significant side effects and an impact on the quality of life.…”

Impact of Octreotide Long-Acting Release on Tumour Growth Control as a First-Line Treatment in Neuroendocrine Tumours of Pancreatic Origin

“…In earlier non-controlled clinical trials in mixed-patient cohorts including NET of different primary tumour origin, stable disease was reported in more than 50% of the patients, whereas tumour remissions occurred in less than 10% of the patients [2]. In patients with documented tumour progression prior to therapy with SSA, stabilisation of disease is reported in up to 40% of the cases [3]. The impact of SSA on tumour growth inhibition has been discussed critically for a long time since tumour evolution of metastatic NET is highly variable and spontaneous tumour growth arrests may occur.…”