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ESMO 2013 WCGC – Recommendations for the management of Pancreatic NET
A review of the presentation by Jaume Capdevila, Barcelona Spain. Unfortunately Neuroendocrine tumours (NETs) are often advanced at the time of diagnosis and the 5 year survival ranges from 30-50%. In pancreatic NETs (pNETs) oncologic radical surgery should be the standard of care.
Limited surgery could be applied in some cases for small pNETs and insulinomas. There is no data to support adjuvant therapy in this area. Jaume Capdevilla explained that hepatic artery chemoembolization and radiofrequency ablation provide an alternative or adjuvant strategy to liver surgery. Tumour size, anatomical location and number of metastases plays a role in determining therapy and impacts on outcomes. The strategy may be to relieve hormone related symptoms and provide tumour control.
Symptom Management
| Symptoms | Treatment options |
| Carcinoid syndrome | Somatostatin analogs |
| Gastrinoma | PPI, somatostatin analogs |
| VIPoma | Somatostatin analogs |
| Glucagonoma | Somatostatin analogs |
| Insulinoma | Everolimus, Somatostatin analogs (SSA) |
Current antiproliferative therapy in G1/G2 pNETs includes chemotherapy, somatostatin analogues, peptide receptor radionuclide therapy (PRRT), everolimus and sunitinib.
Grading G1/G2 (pNETs) versus G3 (pNEC) separates two different diseases in NENs definition. Surgery is the only curative therapy and adjuvant chemotherapy may be considered in G3 pNETs. New targeted therapies have irrupted in the scenario of advanced pNETs, where chemotherapy still has a role and should be integrated with SSA, loco-regional approaches and PRRT. Advanced G3 pNECs have a terrible prognosis where platinum based chemotherapy is active but of short duration. New chemotherapy regimens with targeted therapies are needed in this area.
