New biomarkers for early diagnosis and recurrence of disease will be developed. Molecular imaging will increase in the management of NETs. 68Ga-DOTA octreotate will probably be preferred to Octreoscan in the near future. The novel multireceptor ligand analogue pasireotide has demonstrated efficacy in patients with NETs, including those with metastatic NETs refractory or resistant to, or inadequately controlled with, current somatostatin analogues;[53,91] pasireotide has also shown evidence of antiproliferative effects in vitro.[92,93] A randomized, double-blind Phase III study comparing pasireotide LAR with octreotide LAR in patients with metastatic NETs whose symptoms of carcinoid syndrome were inadequately controlled with their current somatostatin analogue therapy is currently ongoing. It seems likely that somatostatin analogues will be used more frequently in combination with other medical therapies such as mTOR as well as tyrosine kinase inhibitors; positive antiproliferative effects have been seen in patients administered both octreotide LAR and everolimus. Combination trials of everolimus with PRRT will start in Europe as well as everolimus in combination with temozolomide. Sunitinib alone or in combination with somatostatin analogs as well as mTOR inhibitors or VEGF inhibitors (bevacizumab) will be tested. The precise role of everolimus or sunitinib in the treatment algorithm of pancreatic NETs has to be established in forthcoming studies.
Financial & competing interests disclosure
The author has been at the Speakers Bureau for Novartis, Ipsen and Pfizer and also received honoraria from these companies. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Expert Rev Endocrinol Metab. 2011;6(1):49-62. © 2011 Expert Reviews Ltd.
Cite this: Management of Neuroendocrine Tumors: Current and Future Therapies - Medscape - Jan 01, 2011.