What is the potential growth rate range for a grade 2 pancreatic neuroendocrine tumor (PNET) with liver metastasis, Ki-67 index of 5%, in a patient receiving Lanreotide (Somatuline) 120 milligrams every 28 days?

From the Guidelines

For a grade 2 pancreatic neuroendocrine tumor (NET) with liver metastases and a Ki-67 index of 5%, the potential growth rate is typically slow to moderate, with a doubling time that could range from 6 months to 2 years, as supported by the ESMO clinical practice guidelines 1. The current treatment with Lanreotide 120 mg every 28 days is appropriate and can further slow tumor growth, as SSAs can be recommended as first-line therapy for tumor growth control in advanced, slowly-growing SSTR-positive GI and Pan-NETs up to a Ki-67 of 10% 1. Some key points to consider in the management of this patient include:

• The role of Lanreotide in controlling tumor growth and hormone secretion, as it works by binding to somatostatin receptors on tumor cells, inhibiting hormone secretion and tumor proliferation 1.
• The importance of regular imaging every 3-6 months to monitor disease progression, as recommended by the ESMO guidelines 1.
• The potential for additional treatment options if progression occurs despite Lanreotide, including increasing the frequency of Lanreotide, adding everolimus or sunitinib, considering peptide receptor radionuclide therapy (PRRT), or exploring liver-directed therapies for the metastases, as discussed in the ESMO guidelines 1.
• The favorable prognostic factor of a 5% Ki-67 index compared to higher-grade NETs, and the potential for many patients to have stable disease for years with appropriate treatment, as indicated by the ESMO guidelines 1.

From the Research

Potential Growth Rates for Grade 2 Pancreatic Net

• The growth rate of a grade 2 pancreatic neuroendocrine tumor (pNET) that has spread to the liver can vary depending on several factors, including the tumor's Ki-67 index and the patient's treatment regimen 2.
• A study published in 2021 found that patients with grade 2 pNETs and a Ki-67 index ≥10% who received long-acting somatostatin analogs (SSAs) had a median progression-free survival (PFS) of 11.9 months 3.
• However, since the patient in question has a Ki-67 index of 5%, which is lower than the threshold of 10% used in the study, the growth rate may be slower.
• Another study published in 2014 found that lanreotide, a type of SSA, significantly prolonged PFS in patients with metastatic pNETs of grade 1 or 2 (Ki-67 <10%) 4.
• The median PFS in the lanreotide group was not reached, compared to 18.0 months in the placebo group.
• A subsequent study published in 2016 found that long-term treatment with lanreotide maintained favorable safety and tolerability, with a median PFS of 32.8 months 5.

Factors Affecting Growth Rate

• The growth rate of a pNET can be influenced by several factors, including the tumor's grade, stage, and Ki-67 index, as well as the patient's treatment regimen 2, 3.
• The presence of liver metastases can also affect the growth rate, with a higher tumor burden associated with a shorter PFS 3.
• The use of SSAs, such as lanreotide, can slow down the growth rate of pNETs, especially in patients with a lower Ki-67 index 4, 5.

Treatment with Lanreotide

• The patient is receiving lanreotide 120 mg every 28 days, which is a common treatment regimen for pNETs 4, 5.
• The studies suggest that lanreotide can be effective in slowing down the growth rate of pNETs, especially in patients with a lower Ki-67 index 4, 5.
• However, the patient's response to treatment will depend on individual factors, and regular monitoring is necessary to assess the treatment's effectiveness 3, 5.