From the Guidelines
Neuroendocrine tumors (NETs) are rare cancers that develop from specialized cells called neuroendocrine cells, which have characteristics of both nerve cells and hormone-producing cells, and their treatment depends on tumor location, grade, stage, and hormone production, with the primary treatment for localized NETs being surgical resection and for advanced or metastatic disease, treatment options including somatostatin analogs, targeted therapies, peptide receptor radionuclide therapy, and chemotherapy regimens 1.
Definition and Characteristics of Neuroendocrine Tumors
Neuroendocrine tumors (NETs) are rare cancers that arise from neuroendocrine cells, which are found in various organs, including the digestive tract, pancreas, and lungs. These tumors can produce hormones, although not all are hormone-secreting. The treatment of NETs depends on several factors, including tumor location, grade, stage, and hormone production.
Treatment Options for Neuroendocrine Tumors
The primary treatment for localized NETs is surgical resection, which can be curative. For advanced or metastatic disease, treatment options include:
- Somatostatin analogs (octreotide LAR 20-30 mg or lanreotide 90-120 mg every 4 weeks) to control hormone-related symptoms and slow tumor growth
- Targeted therapies (everolimus 10 mg daily or sunitinib 37.5 mg daily for pancreatic NETs)
- Peptide receptor radionuclide therapy (PRRT) with lutetium-177 dotatate for somatostatin receptor-positive tumors
- Chemotherapy regimens (such as capecitabine plus temozolomide) for aggressive, high-grade tumors
- Liver-directed therapies like embolization may be used for liver metastases
Recent Evidence and Recommendations
According to the most recent study 1, the treatment of pancreatic neuroendocrine neoplasms (pan-NENs) involves a multidisciplinary approach, with somatostatin analogs, targeted therapies, and chemotherapy regimens being used to control symptoms and slow tumor growth. The study also highlights the importance of accurate staging and assessment of tumor characteristics to guide treatment decisions.
Key Considerations in Treatment Selection
Treatment selection for NETs is based on tumor characteristics, disease burden, symptoms, and patient factors, with multidisciplinary care being essential due to the complex nature of these tumors and their variable behavior. The choice of treatment should be individualized, taking into account the patient's overall health, tumor characteristics, and treatment goals.
From the FDA Drug Label
Lanreotide injection is a prescription medicine used for: the long-term treatment of people with acromegaly when: surgery or radiotherapy have not worked well enough or they are not able to have surgery or radiotherapy the treatment of adults with a type of cancer known as neuroendocrine tumors, from the gastrointestinal tract or the pancreas (GEP-NETs) that has spread or cannot be removed by surgery.
Definition of Neuroendocrine Tumors: Neuroendocrine tumors (NETs) are a type of cancer that originates from the gastrointestinal tract or the pancreas.
Treatment of Neuroendocrine Tumors: Lanreotide injection is used for the treatment of adults with GEP-NETs that has spread or cannot be removed by surgery. The recommended dosage is 120 mg every 4 weeks 2.
Key Points:
- Neuroendocrine tumors are a type of cancer.
- Lanreotide injection is used to treat GEP-NETs.
- The recommended dosage is 120 mg every 4 weeks.
- Treatment should be administered by a healthcare provider.
From the Research
Definition of Neuroendocrine Tumors
- Neuroendocrine tumors (NETs) are a rare, heterogeneous group of neoplasms with a wide range of malignant potential 3, 4.
- They can manifest as noninfiltrative, slow-growing tumors, locally invasive masses, or even swiftly metastasizing cancers 3.
- NETs are divided into two groups on the basis of clinical behavior, histology, and proliferation rate: well differentiated (low grade to intermediate grade) neuroendocrine tumors and poorly differentiated (high grade) neuroendocrine carcinoma 5.
Treatment of Neuroendocrine Tumors
- Surgery is the only curative treatment and it, therefore, represents the first therapeutic choice for any localized NET 3, 4.
- For patients with small (<2 cm), nonfunctioning G1 tumors, a safe observation approach can be considered 3.
- In the presence of unresectable progressive disease, somatostatin analogs, targeted therapies such as everolimus, peptide receptor radionuclide therapy, and systemic chemotherapy are all useful tools for prolonging survival 3.
- Octreotide and lanreotide are two somatostatin analogs (SSA) currently available in clinical practice, approved for controlling the clinical syndrome associated with functioning NET and for tumor growth control in advanced low/intermediate grade NET 6.
Classification and Staging
- Neuroendocrine tumors of the lung are classified into four main categories: typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC), and small cell lung carcinoma (SCLC) 7.
- The biologic behavior of NETs is defined by the grade and stage of the tumor 3.
- Grading and staging systems facilitate patient risk stratification, and thereby directly impact clinical decision making 4.