1. Pancreatic NETs: where do we stand now?
- Author
-
Faivre S, Castellano D, Strosberg J, González E, and Salazar R
- Subjects
- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biomarkers, Tumor metabolism, DNA Modification Methylases metabolism, DNA Repair Enzymes metabolism, Disease-Free Survival, Everolimus, Humans, Neuroendocrine Tumors diagnosis, Neuroendocrine Tumors enzymology, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms enzymology, Sirolimus therapeutic use, Sunitinib, Treatment Outcome, Tumor Suppressor Proteins metabolism, Indoles therapeutic use, Neuroendocrine Tumors drug therapy, Pancreatic Neoplasms drug therapy, Pyrroles therapeutic use, Sirolimus analogs & derivatives
- Abstract
The systemic management of patients with pancreatic neuroendocrine tumors includes chemotherapy and targeted agents such as everolimus and sunitinib. Which treatment to favor in a particular patient is not known. The most commonly used chemotherapy agents are streptozocin and temozolamide, often prescribed in combination with fluoropyrimidines. A potential biomarker for selection of temozolomide-based chemotherapy is O-6-methylguanine-DNA-methyltrasferase expression. Chemotherapy yields higher response rates and may be preferable in patients with higher-grade tumors and those who are symptomatic. The mammalian target of rapamycin inhibitor everolimus has shown improvement in progression-free survival (PFS) in a robust, well-conducted phase III study. Everolimus, however, can induce limiting toxicities that may result in treatment discontinuation and does not improve survival. However, the objective response rate is very low. Sunitinib, likewise, increases PFS but the data comes from a smaller trial which was terminated early. Sunitinib displays a different toxicity profile and is associated with a trend towards improved overall survival. It is clear that biomarkers to properly select the most effective agents in an individual patient are needed.
- Published
- 2014
- Full Text
- View/download PDF