What is the best treatment for neuroendocrine tumors?

From the Guidelines

The best treatment for neuroendocrine tumors (NETs) is a multidisciplinary approach that depends on several factors including tumor location, grade, stage, and whether it's functional (hormone-producing) or non-functional, with surgery being the primary treatment for localized tumors and somatostatin analogs, targeted therapies, and peptide receptor radionuclide therapy (PRRT) being used for metastatic or unresectable NETs. According to the most recent study 1, the treatment of neuroendocrine tumors should be individualized based on tumor characteristics. Some key points to consider in the treatment of NETs include:

• Surgery is generally the preferred first-line treatment for localized NETs, aiming for complete removal of the tumor 1.
• For metastatic or unresectable NETs, a multidisciplinary approach is recommended, including somatostatin analogs like octreotide LAR or lanreotide to control symptoms in functional tumors and slow tumor growth 1.
• Targeted therapies such as everolimus or sunitinib may be used for progressive disease 1.
• Peptide receptor radionuclide therapy (PRRT) with lutetium-177 dotatate is effective for somatostatin receptor-positive tumors, typically given as four treatments at 8-week intervals 1.
• Chemotherapy regimens, such as capecitabine with temozolomide, are more commonly used for higher-grade, rapidly progressing NETs, particularly those of pancreatic origin 1. Regular monitoring with imaging and biomarkers is essential to assess treatment response and adjust the approach as needed 1.

From the FDA Drug Label

LUTATHERA is indicated for the treatment of adult and pediatric patients 12 years and older with somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs), including foregut, midgut, and hindgut neuroendocrine tumors. Sunitinib malate capsules are indicated for the treatment of progressive, well-differentiated pancreatic neuroendocrine tumors (pNET) in adult patients with unresectable locally advanced or metastatic disease.

The best treatment for neuroendocrine tumors depends on the specific type and location of the tumor.

• Lutetium-177 dotatate (IV) 2 is indicated for somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
• Sunitinib (PO) 3 is indicated for progressive, well-differentiated pancreatic neuroendocrine tumors (pNET) in adult patients with unresectable locally advanced or metastatic disease. It is essential to consult a healthcare professional to determine the most suitable treatment option for each individual case.

From the Research

Treatment Options for Neuroendocrine Tumors

The treatment for neuroendocrine tumors (NETs) depends on various factors, including the location, grade, and stage of the tumor. Some of the treatment options include:

• Surgery: This is often the first line of treatment for NETs, especially for localized tumors.
• Somatostatin analogs: These are used to control hormone-related symptoms and can also be effective in controlling tumor growth 4, 5.
• Targeted therapy: This includes medications such as everolimus and sunitinib, which can be effective in treating well-or moderately-differentiated pancreatic NETs (PNETs) and non-PNETs 6.
• Peptide receptor radionuclide therapy (PRRT): This is a promising treatment for inoperable or metastatic NETs, using radiolabeled somatostatin analogs 4, 5.
• Chemotherapy: This can be used to treat more aggressive tumors, such as neuroendocrine carcinomas, and may include medications such as streptozotocin, 5-fluorouracil, and temozolomide 5, 6.
• Neoadjuvant therapy: This is a relatively new approach, which involves using chemotherapy or radiotherapy before surgery to shrink the tumor and make it easier to remove 7.

Factors Influencing Treatment Choice

The choice of treatment for NETs depends on various factors, including:

• Tumor location: Different locations, such as the small intestine, rectum, and colon, may require different treatment approaches 5.
• Tumor grade and stage: More aggressive tumors may require more intensive treatment, such as chemotherapy or targeted therapy 5, 6.
• Patient symptoms: Somatostatin analogs may be used to control hormone-related symptoms, while other treatments may be used to control tumor growth 4, 5.
• Patient overall health: The patient's overall health and ability to tolerate treatment will also influence the choice of treatment 6.

Emerging Therapies

There are several emerging therapies for NETs, including:

• Radiolabeled somatostatin analogs: These are being used in PRRT to treat inoperable or metastatic NETs 4, 5.
• New targeted therapies: Medications such as everolimus and sunitinib are being used to treat PNETs and non-PNETs 6.
• Neoadjuvant therapy: This is a relatively new approach, which involves using chemotherapy or radiotherapy before surgery to shrink the tumor and make it easier to remove 7.