Key Points in the Initial Treatment of Well-Differentiated Neuroendocrine Tumors (NETs)
- In patients with unresectable, advanced well-differentiated NETs, management includes symptom and oncologic control. All patients with symptoms caused by hormone production should be started on a somatostatin analog (SSA) at diagnosis and continued on it indefinitely.
- Somatostatin analogs also have antitumor effects in gastroenteropancreatic NETs, resulting in significant improvement in progression-free survival; however, their role in the oncologic control of thoracic NETs is unclear.
- Pancreatic NETs are a distinct subgroup of NETs for which there are multiple additional therapeutic options, including targeted agents (sunitinib and everolimus) and conventional chemotherapeutic regimens based on streptozocin or temozolomide. In nonpancreatic NETs, however, there is no proven role for these agents
- Peptide receptor radionuclide therapy and liver-directed therapies, such as transarterial embolization, transarterial chemoembolization, and transarterial radioembolization, are other emerging therapeutic options.