From the Guidelines
Yes, a pancreatic neuroendocrine tumor (NET) that has metastasized to the liver would likely reduce your life expectancy, even with ongoing treatment like Peptide Receptor Radionuclide Therapy (PRRT). While PRRT (typically using Lutathera/lutetium Lu 177 dotatate) can significantly extend survival and control disease progression, metastatic NETs generally remain incurable. The typical treatment regimen involves four infusions of Lutathera given eight weeks apart, with potential maintenance treatments depending on response. Most patients with metastatic pancreatic NETs have a 5-year survival rate of 30-60%, compared to over 90% for localized disease, as reported in a study published in the Journal of the National Comprehensive Cancer Network 1. Your relatively young age of 38 is a positive factor that may improve your prognosis. Additional treatments might include somatostatin analogs like octreotide LAR (Sandostatin) or lanreotide (Somatuline), targeted therapies such as everolimus (Afinitor) or sunitinib (Sutent), and potentially liver-directed therapies. The effectiveness of treatment depends on factors like tumor grade, proliferation rate, somatostatin receptor expression, and overall tumor burden, as outlined in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of gastroenteropancreatic neuroendocrine neoplasms 1. Regular monitoring with imaging, blood tests, and symptom assessment will be essential to evaluate treatment response and adjust your regimen as needed. Some studies have shown that PRRT can improve progression-free survival (PFS) and overall survival (OS) in patients with metastatic NETs, with a PFS of 29 months and an OS of 63 months, as reported in a study published in the Journal of the National Comprehensive Cancer Network 1. However, the choice of treatment should be individualized based on the patient's specific characteristics and tumor features. In your case, since you are 38 years old and have a metastatic pancreatic NET, PRRT could be a viable treatment option, but it's essential to discuss the potential benefits and risks with your healthcare provider and consider other treatment options, such as somatostatin analogs, targeted therapies, and liver-directed therapies. It's also crucial to continue monitoring your disease progression and adjusting your treatment plan accordingly, as recommended by the ESMO clinical practice guidelines 1.
From the Research
Life Expectancy with Pancreatic Neuroendocrine Tumors
- Life expectancy in pancreatic neuroendocrine cancer is lower than that of the general population and varies according to patient age, cancer stage, tumor grade, mode of treatment, and time since diagnosis 2.
- For patients with metastatic high-grade tumors not amenable to surgery, life expectancies are only 1 to 4 years depending on patient age 2.
- Positive factors for survival include younger age, localized stage, low tumor grade, and surgical treatment 2.
- Survival improves over time: on average, mortality rates fell by 1.2% per year after controlling for changes in the patient population 2.
Treatment with PRRT
- Peptide Receptor Radionuclide Therapy (PRRT) is an effective treatment modality for non-operable and metastatic pancreatic neuroendocrine tumors (pNETs) 3.
- Complete response with PRRT is reported to be between 2-6%, while partial response is achieved in up to 60% of cases 3.
- Progression-Free Survival (PFS) with PRRT reaches a mean of 34 months, and Overall Survival (OS) is 53 months 3.
- PRRT also improves patients' Quality of Life (QoL), with acute and sub-acute side effects like nephrotoxicity and haematotoxicity being usually mild and reversible 3.
Impact on Life Expectancy
- While there is no direct evidence on the impact of PRRT on life expectancy in patients with pancreatic neuroendocrine tumors, the available data suggest that PRRT can improve survival and quality of life 4, 5, 3.
- Life expectancy may be reduced due to the metastatic nature of the disease, but treatment with PRRT can potentially improve survival outcomes 2.
- The sequencing and combination of PRRT with other therapies is a challenge for the future of pancreatic neuroendocrine tumor management, and patient, tumor, and logistical factors need to be taken into consideration when selecting therapy 5.