From the Guidelines
Neuroendocrine tumors (NETs) should be managed with somatostatin analogues as the first line of treatment for symptomatic control, particularly for patients with secretory tumors and distressing symptoms from peptide production, as they have been shown to improve quality of life and have a biochemical response rate of 30-70% 1. The treatment of neuroendocrine tumors (NETs) with neurologic symptoms involves a multidisciplinary approach, focusing on managing the underlying tumor and its secreted hormones. Some key points to consider in the management of NETs include:
- Somatostatin analogues, such as octreotide and lanreotide, are the primary treatment for symptomatic control, with a half-life of several hours, making intermittent therapy possible 1.
- The dosage of octreotide can start at 50-100 mg twice or three times a day, with a maximum daily dose of 1500 mg, and can be converted to long-acting somatostatin analogues after stabilization 1.
- Lanreotide, given as a fortnightly or monthly injection, has shown significant improvement in the quality of life of patients and has as good or better efficacy compared to short-acting octreotide 1.
- Patients may experience side effects from somatostatin analogues, including fat malabsorption, gallstones, and vitamin A and D malabsorption, which should be monitored during treatment 1.
- In addition to somatostatin analogues, other treatments such as peptide receptor radionuclide therapy, targeted therapies like everolimus or sunitinib, and symptom control medications like telotristat ethyl or diazoxide may be necessary to manage neurologic symptoms and improve quality of life 1.
From the Research
Neuroendocrine Tumors and Neurologic Symptoms
- Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms that can present with variable clinical symptoms, including neurologic symptoms 2.
- The diagnosis of NETs relies on biochemical markers, computed tomography (CT), magnetic resonance imaging (MRI), and somatostatin-receptor based functional imaging 3, 2.
- Treatment of NETs comprises surgery, somatostatin analogues, peptide receptor radionuclide therapy (PRRT), everolimus, sunitinib, liver-directed therapies, and sometimes chemotherapy 4, 2, 5.
- Neurologic symptoms in NETs can be caused by various factors, including tumor location, hormonal hypersecretion, and treatment side effects 4, 2.
- Somatostatin analogue therapy has been shown to exert antiproliferative effects and inhibit tumor growth via the somatostatin receptor 2 (SSTR2), which can help alleviate neurologic symptoms 4.
- Peptide receptor radionuclide therapy (PRRT) has been successfully employed for the treatment of advanced NETs, demonstrating exceptional tolerability and efficacy 5.
- The management of NETs requires a multidisciplinary approach that integrates clinical, radiological, histopathological, and immunohistochemical data 6.