This review presents a comprehensive comparative analysis of international guidelines for managing advanced, non-functioning, well-differentiated pancreatic neuroendocrine tumors (panNETs). PanNETs, which represent a significant proportion of pancreatic neuroendocrine neoplasms, exhibit diverse clinical behaviors and prognoses based on differentiation, grading, and other molecular markers. The varying therapeutic strategies proposed by different guidelines reflect their distinct emphases and regional considerations, such as the ESMO guideline's focus on advanced disease management and the ENETS guidance paper's multidisciplinary approach. This review examines the most recent guidelines from ESMO, NCCN, ASCO, ENETS, and NANETS, analyzing the recommendations for first-line therapies and subsequent treatment pathways in different clinical scenarios. Significant variations are observed in the recommendations, particularly concerning the choice and sequence of systemic therapies, the role of tumor grading and the Ki-67 index in therapeutic decisions, and the integration of regional regulatory and clinical practices. The analysis highlights the need for a tailored approach to managing advanced NF panNETs, advocating for flexibility in applying guidelines to account for individual patient circumstances and the evolving evidence base. This work underscores the complexities of managing this patient population and the critical role of a multidisciplinary team in optimizing treatment outcomes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Angela Lamarca declares travel and educational support from Ipsen, Pfizer, Bayer, AAA, SirtEx, Novartis, Mylan, Delcath Advanz Pharma and Roche. Speaker honoraria from Merck, Pfizer, Ipsen, Incyte, AAA/Novartis, QED, Servier, Astra Zeneca, EISAI, Roche, Advanz Pharma and MSD; advisory and consultancy honoraria from EISAI, Nutricia, Ipsen, QED, Roche, Servier, Boston Scientific, Albireo Pharma, AstraZeneca, Boehringer Ingelheim, GENFIT, TransThera Biosciences, Taiho and MSD; principal Investigator-associated Institutional Funding form QED, Merck, Boehringer Ingelheim, Servier, Astra Zeneca, GenFit, Panbela Therapeutics, Novocure GmbH, Camurus AB, Albireo Pharma, Taiho, TransThera, Jazz Therapeutics and Roche; she was also a member of the Knowledge Network and NETConnect Initiatives funded by Ipsen. Nicola Fazio: IPSEN, Advisory Board, Personal; Merck, Advisory Board, Personal; MSD, Advisory Board, Personal; NOVARTIS, Other, Personal, Steering committee; NOVARTIS, Invited Speaker, Personal; NOVARTIS, Advisory Board, Personal; Astellas, Local PI, Institutional, Financial interest; Beigene, Local PI, Institutional, Financial interest; Boehringer, Local PI, Institutional, Financial interest; FIBROGEN, Local PI, Institutional, Financial interest; IPSEN, Local PI, Institutional, Financial interest; IPSEN, Research Grant, Institutional, Financial interest; ITM, Local PI, Institutional, Financial interest; Merck, Research Grant, Institutional, Financial interest; MSD, Local PI, Institutional, Financial interest; NOVARTIS, Research Grant, Institutional, Financial interest; NUCANA, Local PI, Institutional, Financial interest. Non-Financial Interests: AIOM, Other, Internal reviewer of NET guidelines; ENETS, Member of Board of Directors; ESMO, Other, Member of the NET Faculty; SPARC Europe, Other, Steering committee. Francesco Panzuto: Advisor honoraria form Mylan (Viatris), Advanz pharma. Novartis, Camurus, Ipsen, Local PI, Institutional. Non-financial interest: AIOM, author of NET guidelines; ENETS, chair of the advisory board; Itanet, chief of the society]., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)