From the Guidelines
The treatment for your grade 2 pancreatic neuroendocrine tumor (NET) with potential residual disease and liver metastases will likely involve ongoing monitoring and management over the next 10-15 years, with a focus on controlling tumor growth and managing symptoms, as evidenced by recent studies 1. Your current lanreotide 120mg therapy is appropriate as a first-line treatment to control tumor growth and manage any hormonal symptoms. Moving forward, you can expect regular imaging every 3-6 months initially (MRI or CT scans), gradually extending to annual scans if disease remains stable, as suggested by guidelines 1. Blood tests to monitor tumor markers like chromogranin A and specific hormones will be part of your routine follow-up. If your disease progresses, additional treatments may include switching to other somatostatin analogs like octreotide LAR, or adding targeted therapies such as everolimus (10mg daily) or sunitinib (37.5mg daily), as recommended by recent guidelines 1. For the liver lesions, local treatments like radiofrequency ablation, transarterial chemoembolization, or surgical resection might be considered if they grow. Peptide receptor radionuclide therapy (PRRT) with lutetium-177 dotatate might be recommended if other treatments fail, as supported by recent studies 1. Throughout this journey, managing side effects from lanreotide (like gastrointestinal issues and fatigue) and maintaining good nutrition will be important aspects of your care. The good news is that many patients with grade 2 NETs can have long-term survival with appropriate management, even with metastatic disease, as reported in recent studies 1.
Some key points to consider in your treatment plan include:
- Regular monitoring with imaging and blood tests to track disease progression
- Adjusting treatment as needed to control symptoms and tumor growth
- Considering local treatments for liver lesions if they grow
- Potential use of PRRT if other treatments fail
- Managing side effects and maintaining good nutrition throughout your care
- Recent studies suggest that PRRT may be effective in controlling tumor growth and improving survival in patients with grade 2 NETs, as reported in 1 and 1.
It's essential to work closely with your healthcare team to develop a personalized treatment plan that takes into account your specific needs and circumstances, as recommended by guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Overview
- The treatment for pancreatic neuroendocrine tumors (pNETs) depends on the grade and stage of the tumor, as well as the presence of metastases 2.
- In the case of a grade 2 pNET with potential residual tumor in the pancreas and liver metastases, a multidisciplinary approach is necessary, involving surgery, systemic therapy, and possibly liver-directed therapies 2, 3.
Systemic Therapy
- Somatostatin analogs, such as lanreotide, are commonly used to control symptoms and slow tumor growth in patients with pNETs 2.
- Targeted therapies, such as everolimus, and peptide receptor radionuclide therapy (PRRT) may also be considered for patients with advanced or metastatic pNETs 2, 4.
- The use of sunitinib in tandem with PRRT has shown promise in a case report, but further studies are needed to confirm its efficacy 5.
Surgery
- Radical surgery may be considered for patients with resectable tumors, while palliative surgery may be beneficial for patients with non-functional metastatic G2 pNETs, as shown in a 20-year single-center retrospective analysis 6.
- Liver-directed therapies, such as resection or ablation, may also be considered for patients with liver metastases 2.
Follow-up and Monitoring
- Regular follow-up and monitoring are crucial to assess the response to treatment and detect any potential progression of the disease 4, 3.
- Imaging studies, such as CT or MRI scans, and biomarker tests may be used to monitor the disease and adjust treatment as needed 2, 3.
Potential Treatment Options
- Based on the current evidence, potential treatment options for the next 10-15 years may include:
- Continued use of lanreotide or other somatostatin analogs to control symptoms and slow tumor growth.
- Consideration of targeted therapies, such as everolimus, or PRRT for disease control.
- Evaluation of the potential benefits of palliative surgery or liver-directed therapies for patients with liver metastases.
- Regular follow-up and monitoring to assess the response to treatment and adjust the treatment plan as needed. 2, 4, 5, 3, 6