From the Guidelines
The reduction in life expectancy for a 38-year-old with a resected 4.2 cm pancreatic neuroendocrine tumor (NET) that has metastasized to the liver is difficult to predict precisely, but generally ranges from 5-15 years compared to age-matched controls. The current treatment with lanreotide 120 mg every 28 days is appropriate for controlling tumor growth and symptoms, as supported by the guidelines for the management of gastroenteropancreatic neuroendocrine tumors 1. Prognosis depends on several factors including the tumor's Ki-67 proliferation index, differentiation grade, and response to treatment. Well-differentiated NETs with low Ki-67 indices have better outcomes, with some patients living 10+ years after diagnosis despite liver metastases, as reported in a study of 172 patients who underwent hepatic resection of metastatic NETs, showing a 10-year overall survival rate of 50.4% 1. The "barely detectable" liver metastasis is actually a positive prognostic factor compared to extensive liver involvement. Regular monitoring with imaging (MRI/CT every 3-6 months), chromogranin A blood tests, and potentially additional nuclear medicine scans like Gallium-68 DOTATATE PET/CT would be recommended. If disease progression occurs, additional treatment options include increasing lanreotide frequency, adding everolimus or sunitinib, considering peptide receptor radionuclide therapy (PRRT), or liver-directed therapies, as discussed in the NCCN guidelines for neuroendocrine and adrenal tumors 1. The young age and absence of comorbidities are favorable factors that may allow for more aggressive treatment approaches if needed. Some key points to consider in the management of this patient include:
- The importance of regular monitoring and imaging to assess disease progression and response to treatment
- The potential benefits of somatostatin analogues, such as lanreotide, in controlling tumor growth and symptoms
- The consideration of additional treatment options, such as everolimus or sunitinib, if disease progression occurs
- The potential role of liver-directed therapies, such as hepatic resection or embolization, in the management of liver metastases.
From the Research
Reduction in Life Expectancy
- The reduction in life expectancy for a patient with a pancreatic neuroendocrine tumor (PNET) that has metastasized to the liver is difficult to quantify, as it depends on various factors such as the tumor's grade, size, and response to treatment 2.
- However, studies have shown that patients with PNETs that have metastasized to the liver can still achieve long-term survival with appropriate treatment, including surgery, liver-directed therapy, and peptide receptor radionuclide therapy (PRRT) 2, 3.
Treatment with Lanreotide
- The patient is currently being treated with lanreotide 120 mg every 28 days, which has been shown to prolong progression-free survival in patients with metastatic pancreatic and intestinal neuroendocrine tumors 4.
- Lanreotide has also been shown to have anti-tumor effects and improve tumor symptoms and quality of life in patients with PNETs 4.
Prognosis
- The prognosis for the patient is uncertain, but studies have shown that patients with PNETs that have metastasized to the liver can still achieve long-term survival with appropriate treatment 2, 3.
- The fact that the patient's liver metastases are barely detectable is a positive sign, and the use of lanreotide and potential future treatments such as PRRT may help to control the disease and improve the patient's quality of life 3, 5.
Potential Future Treatments
- PRRT is a potential future treatment option for the patient, which has been shown to prolong progression-free and overall survival, reduce or stabilize tumor burden, and improve tumor symptoms and quality of life in patients with PNETs 3, 5.
- However, PRRT can also cause adverse events such as hepatotoxicity, and the patient's liver function will need to be closely monitored if this treatment is considered 6.