Published online Jan 15, 2017. doi: 10.4251/wjgo.v9.i1.4
Peer-review started: June 29, 2016
First decision: August 26, 2016
Revised: October 13, 2016
Accepted: November 21, 2016
Article in press: November 22, 2016
Published online: January 15, 2017
Neuroendocrine (NE) gastroenteropancreatic tumors are a heterogeneous group of neoplasias arising from neuroendocrine cells of the embryological gut. Their incidence have increased significantly over the past 3 decades probably due to the improvements in imaging and diagnosis. The recent advances in molecular biology have translated into an expansion of therapeutic approaches to these patients. Somatostatin analogs, which initially were approved for control of hormonal syndromes, have recently been proven to inhibit tumor growth. Several new drugs such as antiangiogenics and others targeting mammalian target of rapamycin pathways have been approved to treat progressive pancreatic neuroendocrine tumors (NETs) although their role in non-pancreatic is still controversial. The treatment of NETs requires a coordinated multidisciplinary approach. The management of localized NETs primarily involves surgical resection followed by surveillance. However, the treatment of unresectable and/or metastatic disease may involve a combination of surgical resection, systemic therapy, and liver-directed therapies with the goal of alleviating symptoms of peptide release and controlling tumor growth. This article will review the current therapeutic strategies for metastatic gastroenteropancreatic NETs and will take a glimpse into the future approaches.
Core tip: The management of localized NETs is straight forward, however, the treatment of advanced tumors involves several disciplines and requires a coordinated multidisciplinary approach. Recent advances in molecular biology have expanded the therapeutic arsenal. Somatostatin analogs, initially approved for control of hormonal syndromes, have recently proven to inhibit tumor growth. Several new drugs, antiangiogenics, mTOR inhibitors have been tested with promising results and some of them have already been approved. Several trials are still under way but the future should focus on patient selection, predictive markers, and tolerability improvement as critical aspects to continue advancing.