MODERN APPROACHES AND RECENT ADVANCES IN NEUROENDOCRINE TUMORS

Modern Approaches and Recent Advances in Neuroendocrine Tumors-kapak

CHOICES IN TREATMENT AND SEQUENCING FOR PATIENTS WITH METASTATIC WELL-DIFFERENTIATED GEP-NETS

Burcu Bacak1 Bülent Çetin2

1Afyonkarahisar Health Science University, Faculty of Medicine, Department of Medical Oncology, Afyonkarahisar,Türkiye
2Ondokuz Mayıs University, Faculty of Medicine, Department of Medical Oncology, Samsun, Türkiye

Bacak B, Çetin B. Choices in Treatment and Sequencing for Patients with Metastatic Well-Differentiated GEPNETs. In: Gönüllü E, Karaman K, editors. Modern Approaches and Recent Advances in Neuroendocrine Tumors. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.207-217.

ABSTRACT

Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are rare tumours but their incidence is increasing. Survival in metastatic disease is very poor. There is no clear consensus on the appropriate sequence of therapies currently used in metastatic well-differentiated GEP-NETs. A multidisciplinary assessment should be performed to determine the best choice of treatment for metastatic disease. Treatment decisions should be tailored to the individual patient based on performance status, comorbidities and therapeutic goals. Tumour somatostatin receptor status, primary site, Ki-67 expression, growth rate, patient symptom burden, access to treatment and clinical evaluation for neuroendocrine tumour (NET)-related genetic and/or hormonal syndromes are other factors that influence treatment decisions. Observation should be considered in asymptomatic patients with stable disease and low tumour burden. Treatment options include local regional therapies, cytoreductive surgery or systemic therapies. Systemic therapies include somatostatin analogues, peptide receptor radionuclide therapies, molecularly targeted therapies, cytotoxic chemotherapies and agents such as immunotherapies that are still in clinical trials. In patients with symptoms of hormone hypersecretion, other non-cytotoxic therapies that may reduce hormone secretion or alleviate the effects of secretion are also used, depending on the specific syndrome. Although there are no clear algorithms for treatment management due to the rarity of the disease, clinical trials in this area are becoming increasingly important.

Keywords: Gastro-enteropancreatic neuroendocrine tumor; Neoplasm metastasis; Interdisciplinary communication; Receptors, somatostatin; Antineoplastic agents; Molecular targeted therapy; Clinical trial

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