Medical Treatment of Gastrointestinal Neuroendocrine Neoplasms

Medical Treatment of Gastrointestinal Neuroendocrine
Neoplasms:

Horm Metab Res
DOI: 10.1055/a-1110-7251

Neuroendocrine neoplasms (NENs) are rare tumours that arise mainly in the
gastrointestinal or pulmonary system. Most NENs are well-differentiated and
may obtain prolonged survival besides the presence of metastatic disease;
however, a subset (poorly differentiated NENs) may display a truly
aggressive behaviour exhibiting a poor prognosis. The recently developed
classification systems along with advances in functional imaging have helped
stratify patients to the administration of appropriate therapeutic options.
Surgery is the mainstay of treatment of NENs, but in recent decades there
has been a considerable evolution of medical treatments that are used for
locally advanced or metastatic disease not amenable to surgical resection.
Long acting somatostatin analogues are the main therapeutic modality for
patients with functioning and well-differentiated low grade NENs exhibiting
symptomatic control and mainly stabilisation of tumour growth. Other
systemic treatments include chemotherapy, molecular targeted agents,
interferon-α, peptide receptor radionuclide therapy (PRRT), and
immunotherapy. In addition, new agents such as telotristat may be used for
the control of symptoms of carcinoid syndrome. The choice and/or
sequence of therapeutic agents should be individualized according to tumour
origin and differentiation, disease burden, presence of clinical symptoms
and patients’ performance status in the context of a
multidisciplinary approach. Recent advances in the molecular pathogenesis of
NENs set the field for a more personalised treatment approach.
[...]

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