The emerging role of targeted therapies for advanced well-differentiated gastroenteropancreatic neuroendocrine tumors

Expert Rev Clin Pharmacol. 2019 Feb;12(2):101-108. doi: 10.1080/17512433.2019.1561273. Epub 2019 Jan 16.

Abstract

Gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are unique and complex neoplasms, exhibiting a wide spectrum of diverse clinical behaviors. The contemporary management of well-differentiated GEP-NETs is marked by the availability of a wide range of targeted therapies. Areas Covered: For patients with localized or oligometastatic disease, surgical resection remains the preferred approach and is associated with excellent long-term outcomes. For patients with unresectable but isolated liver metastases, multiple liver-directed therapies, including hepatic arterial based therapies and ablative techniques, exist. For patients with metastatic and progressive disease, a number of systemic therapies exist: molecular targeted agents, peptide receptor radionuclide therapy (PRRT), and systemic chemotherapy. Furthermore, somatostatin analogs (SSA) are an important component of therapy, both effectively controlling symptoms of hormonal overproduction and contributing to slowing tumor progression. Expert Opinion: In the near future, advances in our understanding of tumor biology, genetics, immunology, nanotechnology, and radiation pharmacology should only continue to expand the availability of targeted therapies, improving the outcomes of patients with GEP-NETs. We herein review the management of advanced well-differentiated GEP-NETS with a particular emphasis on the role of targeted therapies.

Keywords: Neuroendocrine; PRRT; gastroenteropancreatic; targeted agents; therapy; treatment.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Disease Progression
  • Humans
  • Intestinal Neoplasms / pathology
  • Intestinal Neoplasms / therapy*
  • Molecular Targeted Therapy*
  • Neoplasm Metastasis
  • Neuroendocrine Tumors / pathology
  • Neuroendocrine Tumors / therapy*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy*
  • Somatostatin / analogs & derivatives
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / therapy*

Substances

  • Antineoplastic Agents
  • Somatostatin

Supplementary concepts

  • Gastro-enteropancreatic neuroendocrine tumor