Chemotherapy in Well Differentiated Neuroendocrine Tumors (NET) G1, G2, and G3: A Narrative Review
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Published on: February 12, 2017
Arianna Zappi1, Irene Persano2, Linda Galvani1
1Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy.
Abstract:
Neuroendocrine tumors (NETs) are rare neoplasms with a wide spectrum of clinical behavior, from the long survival of well-differentiated NETs to the dismal prognosis of high-grade neuroendocrine carcinomas (NECs), being G3 NETs a recently recognized intermediate entity. While the role of chemotherapy is well established in NECs, data on NETs mostly derives from small studies, experts' opinions, and extrapolating results from small-cell lung cancer studies. This narrative review aims to summarize available evidence about the use of chemotherapy in the setting of G1-2 NETs and G3 NETs. We performed literature research in PubMed Library for all articles published up to September 2022 about the efficacy of chemotherapy in NETs. Treatment regimens with STZ-5FU, CAPTEM, and anti-metabolite-based treatment are the most active and tolerated in gastroenteropancreatic NETs (GEP-NETs) G1-G2, while platinum-based regimens (FOLFOX/XELOX) and TEM/CAPTEM showed the best activity in thoracic NETs. Solid evidence about chemotherapy efficacy in G3 NETs is still lacking. Literature data support the use of chemotherapy in low-intermediate grade NETs after the failure of other therapies or if tumor shrinkage is needed. Studies assessing G3 NETs independently from NECs are needed to better understand the role of chemotherapy in this setting.
Insights
Chemotherapy shows efficacy in low-to-intermediate grade neuroendocrine tumors (NETs) after other treatments fail or for tumor shrinkage. More research is needed on chemotherapy
Area of Science:
- Oncology
- Medical Research
Background:
- Neuroendocrine tumors (NETs) exhibit diverse clinical behaviors, ranging from indolent to aggressive.
- G3 NETs represent a newly identified intermediate category between well-differentiated NETs and high-grade neuroendocrine carcinomas (NECs).
- Chemotherapy's role in NECs is established, but evidence in NETs is limited, often relying on small studies or extrapolations.
Purpose of the Study:
- To review and synthesize current evidence on chemotherapy efficacy in G1-2 and G3 NETs.
- To identify effective chemotherapy regimens for different NET subtypes and grades.
Main Methods:
- A narrative review of literature was conducted.
- PubMed database was searched for articles published up to September 2022 on chemotherapy efficacy in NETs.
Main Results:
- For gastroenteropancreatic (GEP) NETs G1-G2, STZ-5FU, CAPTEM, and anti-metabolite regimens are most active and tolerated.
- For thoracic NETs, platinum-based regimens (FOLFOX/XELOX) and TEM/CAPTEM demonstrate the best activity.
- Robust evidence for chemotherapy efficacy in G3 NETs is currently lacking.
Conclusions:
- Chemotherapy is supported for low-intermediate grade NETs when other therapies fail or tumor reduction is necessary.
- Further studies are required to evaluate G3 NETs independently of NECs to clarify chemotherapy's role.
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