Metastatic pancreatic neuroendocrine tumors (pNET): placing current findings into perspective

Progress during the past 3 decades in the treatment of advanced neuroendocrine tumors (NET) has been slow, despite a substantial increase in the incidence of NET at all primary sites and stages of disease. In the United States, the annual incidence of pancreatic NET (pNET) was estimated as 0.32 per 100,000 people in 2004. Until recently, there were few available therapies for the treatment of patients with advanced pNET. Nonetheless, substantial strides have been made within the past several years. In 2011, 2 new systemic therapies (everolimus and sunitinib) were approved by the US Food and Drug Administration (FDA) for the treatment of patients with advanced pNET, based on recently published results from 2 phase III studies. Additions to the pNET treatment arsenal significantly expanded options for clinicians who treat these patients. However, important differences between the key clinical studies existed, preventing optimal direct comparison of the study results. Therefore, the clinical implications of these study results continue to be debated. The following commentary briefly summarizes the background of NET and provides an overview of available options, highlighting the important findings of the 2 pivotal studies. In this review, the data supporting the use of everolimus and sunitinib in advanced pNET are reviewed, and the incorporation of these targeted therapies into a pNET treatment algorithm is further discussed.