My burning issues in neuroendocrine tumours (NET)

Area of Science:

• Oncology
• Nuclear Medicine
• Pharmacology

Background:

• Advanced well-differentiated neuroendocrine tumors (NET) of gastroenteropancreatic (GEP) or lung origin have seen recent therapeutic advancements.
• Somatostatin analogues (SSA) are established as first-line treatment for GEP-NET, offering antiproliferative and symptomatic benefits.
• Everolimus, an mTOR inhibitor, is approved for progressive GEP- and lung-NET.

Purpose of the Study:

• To review current systemic treatment options for advanced neuroendocrine tumors.
• To discuss the role of somatostatin analogues (SSA), everolimus, and peptide receptor radionuclide therapy (PRRT).
• To highlight emerging areas of research including NET G3 and immunotherapy.

Main Methods:

• Review of pivotal clinical trials (PROMID, CLARINET) for SSA efficacy.
• Analysis of recent data on everolimus use in GEP- and lung-NET.
• Evaluation of current evidence and expert opinion on PRRT for midgut and non-midgut NET.

Main Results:

• SSA are the preferred first-line treatment for GEP-NET, providing antiproliferative and symptomatic relief.
• PRRT is a standard treatment for midgut-NET progressing on SSA, with ongoing discussion regarding its use in non-midgut NET.
• Optimal treatment strategies for NET G3 and the potential of immunotherapy are active areas of investigation.

Conclusions:

• Current systemic therapies for advanced NET include SSA, everolimus, and PRRT, with specific indications based on tumor origin and progression.
• PRRT is highly effective for midgut-NET and its application in other NET sites requires individualized multidisciplinary assessment.
• Future research directions focus on refining treatment for NET G3 and exploring the efficacy of immunotherapy in NET.