Management of Neuroendocrine Tumors: Current and Future Therapies

Kjell E Öberg


Expert Rev Endocrinol Metab. 2011;6(1):49-62. 

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Expert Commentary

The incidence and prevalence of NETs is increasing; however, it is possible to prolong survival with appropriate surgical and/or medical therapy. Since a majority of patients present with metastatic disease at diagnosis, it is important to develop new sensitive biomarkers for early detection and prognosis. Molecular imaging will be an important tool in staging and monitoring of the disease during therapy. Surgery to remove the primary malignancy and/or local lymph nodes is the only possible curative approach and so represents the traditional first-line therapy. Somatostatin analogs are the mainstay of therapy for the alleviation of symptoms of so-called functioning tumors. Results from the PROMID study suggest that octreotide LAR 30 mg is an effective antiproliferative treatment in patients with newly diagnosed, functionally active or inactive, well-differentiated metastatic midgut NETs. Everolimus achieves an antiproliferative effect in patients with NETs and may have a synergistic effect in combination with octreotide LAR in patients with metastatic low- to intermediate-grade NETs and in patients with advanced pancreatic NETs following failed chemotherapy. Sunitinib seems to be of benefit in patients with pancreatic NETs. Pasireotide, as a multireceptor ligand somatostatin analogue, has the potential to be effective in patients with de novo or octreotide-refractory carcinoid syndrome and for inhibiting tumor cell proliferation; combination therapy with pasireotide and everolimus is also under evaluation.


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