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Emerging therapeutic options for advanced enteropancreatic neuroendocrine tumors
Constantin A Dasanu1, Shounak Majumder, Srila Gopal
1Department of Hematology-Oncology, St. Francis Hospital and Medical Center, Hartford, CT 06105, USA. c_dasanu@yahoo.com
Introduction:
Several chemotherapy agents and combinations have proven effective in the therapy of advanced enteropancreatic neuroendocrine tumors (EP-NETs). However, their toxicity can be significant. Recent understanding of the molecular mechanisms of these tumors, especially the central role of tumor angiogenesis, has led to the identification of new therapeutic targets and agents directed at the molecular level.
Areas Covered:
This paper gives a comprehensive evaluation of the existing therapeutic armamentarium for EP-NETs. Narrated in a historical perspective, this review analyzes the available information on traditional chemotherapy agents, interferon-α and somatostatin analogs, as well as newer therapies and experimental agents.
Expert Opinion:
Despite recent advances, a curative approach for metastatic EP-NETs is yet to be discovered. To date, sunitinib and everolimus have been shown to impact progression-free survival only in pancreatic NETs, and the duration of this benefit has not yet been established. Further research is necessary to determine whether a combination of these drugs, either together or with other therapies, may yield superior outcomes. Moreover, sequential use of these agents should be explored in an attempt to improve survival. Efficacy of a variety of experimental agents is also being tested in clinical trials.
Insights
Current treatments for advanced enteropancreatic neuroendocrine tumors (EP-NETs) show limited efficacy and significant toxicity. New molecularly targeted agents offer promise, but further research is needed to establish optimal therapeutic strategies for improved patient outcomes.
Area of Science:
- Medical Oncology
- Gastroenterology
- Translational Research
Background:
- Advanced enteropancreatic neuroendocrine tumors (EP-NETs) pose treatment challenges due to chemotherapy toxicity.
- Tumor angiogenesis is a key molecular mechanism in EP-NETs, identifying new therapeutic targets.
- Understanding molecular pathways is crucial for developing novel, targeted therapies.
Purpose of the Study:
- To provide a comprehensive evaluation of current and emerging therapies for EP-NETs.
- To analyze traditional chemotherapy, interferon-α, somatostatin analogs, and newer agents.
- To review experimental therapies currently under investigation.
Main Methods:
- Historical perspective review of therapeutic armamentarium for EP-NETs.
- Analysis of existing data on chemotherapy, interferon-α, and somatostatin analogs.
- Evaluation of newer and experimental therapeutic agents.
Main Results:
- Sunitinib and everolimus show progression-free survival benefits in pancreatic NETs, with duration yet to be established.
- No curative approach currently exists for metastatic EP-NETs.
- Efficacy of various experimental agents is under evaluation in clinical trials.
Conclusions:
- Curative treatment for metastatic EP-NETs remains elusive.
- Further research is essential to optimize combination and sequential therapies.
- Exploration of novel agents is ongoing to improve survival outcomes in EP-NET patients.
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