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Published on: April 17, 2019
Update on management of midgut neuroendocrine tumors
Amir Mehrvarz Sarshekeh1, Daniel M Halperin1, Arvind Dasari1
1Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Abstract:
Midgut neuroendocrine tumors are typically indolent but can be fatal when advanced. They can also cause significant morbidity due to the characteristic carcinoid syndrome. Somatostatin analogs continue to be the mainstay of treatment given their antiproliferative properties, as well as inhibitory effects on hormones that cause carcinoid syndrome. There have been several recent advances in the systemic therapy of these tumors including consolidation of somatostatin analogs as the cornerstone of therapy, completion of pivotal trials with mTOR inhibitors, and the establishment of novel approaches including peptide receptor radionuclide therapy and oral inhibitors of peripheral tryptophan hydroxylase in tumor and symptom control, respectively. In this review article, the recent advances are summarized and an updated approach to management is proposed.
Insights
Midgut neuroendocrine tumors (NETs) are often slow-growing but can be fatal. Recent advances in systemic therapy, including somatostatin analogs and novel agents, offer improved tumor and symptom control for advanced disease.
Area of Science:
- Oncology
- Endocrinology
- Gastroenterology
Background:
- Midgut neuroendocrine tumors (NETs) are typically indolent but can become fatal in advanced stages.
- Carcinoid syndrome, a complication of NETs, causes significant patient morbidity.
- Somatostatin analogs are the current standard treatment due to antiproliferative and hormone-inhibiting effects.
Purpose of the Study:
- To summarize recent advancements in the systemic therapy of midgut neuroendocrine tumors.
- To propose an updated management strategy based on new therapeutic options.
Main Methods:
- Review of recent clinical trials and therapeutic advancements in midgut NETs.
- Consolidation of established therapies and integration of novel approaches.
Main Results:
- Somatostatin analogs remain a cornerstone therapy for midgut NETs.
- mTOR inhibitors have completed pivotal trials, showing efficacy.
- Novel therapies like peptide receptor radionuclide therapy and oral tryptophan hydroxylase inhibitors offer new avenues for tumor and symptom control.
Conclusions:
- Recent advances have expanded systemic therapy options for midgut NETs.
- An updated, evidence-based approach to management is proposed, integrating novel therapies.
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