Ten-Year Disease Control of Metastatic Pancreatic Neuroendocrine Tumour Treated With Everolimus

Management of metastatic pancreatic neuroendocrine tumours remains challenging due to clinical heterogeneity and limited high-quality evidence, especially regarding treatment beyond first-line therapy. Optimal treatment strategies in the second-line setting are not well established. We report the case of a woman in her late 30s who presented with progressively debilitating back pain and was diagnosed with an intermediate-grade pancreatic neuroendocrine tumour with bone and liver metastases. Based on negative findings on somatostatin receptor-based imaging, she commenced first-line chemotherapy with capecitabine and temozolomide. In parallel, local therapy for bone metastases was administered through radiotherapy and surgical intervention. After eight months of therapy, there was significant disease progression, with numerous bone and lymph node metastases. At this point, treatment was switched to everolimus as second-line therapy. The patient experienced rapid functional improvement, a marked reduction in tumour burden, and only manageable side effects (stomatitis and hypertriglyceridaemia). Over time, she achieved sustained disease control with everolimus. This case illustrates a durable clinical response to second-line everolimus in a patient with metastatic pancreatic neuroendocrine tumour and adds to the growing clinical experience with this treatment. It also highlights the benefits of a multidisciplinary approach to the management of metastatic disease.