What are the prognosis, treatment options, and life expectancy for a 38-year-old patient with a resected pancreatic neuroendocrine tumor (PNET) that has metastasized to the liver, with a grade 2 tumor and 5% mitotic count?

From the Guidelines

For a 38-year-old with a resected pancreatic neuroendocrine tumor (NET) that has metastasized to the liver with multiple spots visible on MRI, the most appropriate treatment approach is surgical resection of liver metastases if they are limited and accessible, which offers the best chance for long-term survival, as supported by the most recent and highest quality study 1. The grade 2 classification with a 5% mitotic count indicates an intermediate-grade tumor with moderate aggressiveness. Some key points to consider in the management of this condition include:

• Treatment options:
  • Surgical resection of liver metastases if limited and accessible
  • Liver-directed therapies such as radiofrequency ablation, transarterial chemoembolization, or radioembolization if surgery isn't feasible
  • Systemic treatments including somatostatin analogs like octreotide LAR or lanreotide
  • Targeted therapies such as everolimus or sunitinib for more aggressive disease
  • Peptide receptor radionuclide therapy (PRRT) with lutetium-177 dotatate if tumors show somatostatin receptor expression
• Prognosis: varies widely, but with modern treatments, median survival often ranges from 3-10 years, with some patients living much longer, as indicated by 1 and 1
• Monitoring: regular imaging every 3-6 months and tumor marker tests (chromogranin A) are essential to assess treatment response, as recommended by 1 and 1 This condition should be managed by a multidisciplinary team specializing in neuroendocrine tumors to determine the optimal personalized treatment approach, considering the latest guidelines and evidence from studies such as 1 and 1.

From the FDA Drug Label

A clinically significant improvement for sunitinib over placebo in PFS was seen by both investigator and independent assessment. A hazard ratio favoring sunitinib was observed in all subgroups of baseline characteristics evaluated. Table 15 pNET Efficacy Results from Study 6 Efficacy Parameter Sunitinib (N = 86) Placebo (N = 85) p-value HR (95% CI) Progression-free survival [median, months (95% CI)] 10.2 (7.4,16.9) 5.4 (3.4,6.0) 0.000146 a 0.427 (0.271,0.673)

The options for a 38-year-old who had a pancreatic net that was resected but found out that it had metastasized to the liver are limited.

• Sunitinib may be considered as a treatment option, as it has shown a clinically significant improvement in progression-free survival (PFS) compared to placebo in patients with unresectable pancreatic neuroendocrine tumors (pNET) 2.
• The prognosis is generally poor for patients with metastatic pNET, but the use of sunitinib may help to improve PFS.
• Life expectancy is difficult to predict and depends on various factors, including the extent of liver metastases and the patient's overall health.
• The patient's tumor grade (grade 2) and mitotic count (5%) may also impact the prognosis and treatment options.

From the Research

Prognosis and Life Expectancy

• The prognosis for a 38-year-old patient with a pancreatic neuroendocrine tumor (pNET) that has metastasized to the liver is generally poor 3.
• However, the life expectancy can vary depending on the grade and stage of the tumor, as well as the effectiveness of treatment 4.
• A study found that the median overall survival (OS) for patients with metastatic pNETs treated with sunitinib was 54.1 months 5.

Treatment Options

• Surgery is the only curative treatment for pNETs, but in cases where the tumor has metastasized to the liver, an aggressive surgical approach towards liver metastases may be recommended 4.
• Liver-directed therapies, such as hepatic artery embolization, may also be used to control the disease 3.
• Systemic therapies, including somatostatin analogs, targeted therapies like everolimus, peptide receptor radionuclide therapy, and systemic chemotherapy, may be used to prolong survival 4, 6, 7.
• Sunitinib, a multitarget tyrosine kinase inhibitor, has been shown to improve progression-free survival and overall survival in patients with advanced pNETs 7, 5.

Grade and Mitotic Count

• The patient's tumor is grade 2 with a 5% mitotic count, which indicates a moderately differentiated tumor with a moderate proliferation rate.
• The grade and mitotic count can help guide treatment decisions, but the overall prognosis and treatment options will depend on a comprehensive evaluation of the patient's condition 4.