Management of Metastatic Small Intestinal Carcinoid Tumor (Grade 1) Without Carcinoid Syndrome
- A watch-and-wait approach is an initial option for the patient with “low bulk” asymptomatic metastatic grade 1 small intestinal NETs presenting without carcinoid syndrome.
- Serial biochemical measurements (eg, urinary/plasma 5-HIAA and chromogranin A levels) may be useful in assessing efficacy and detecting progression.
- An OctreoScan at the time of diagnosis allows for the evaluation of occult sites that may influence the initial care plan, guide surveillance, and establish whether PRRT is a future therapeutic option.
- Initiation of therapy with somatostatin analogs is recommended prior to surgical procedures (such as an exploratory laparotomy for obstructive intestinal symptoms despite the absence of carcinoid syndrome).
- The assessment of disease bulk is critical in determining if and when a locoregional approach should be combined with systemic therapy.
- At the time of clinical or radiographic progression, targeted therapy should be initiated with somatostatin analogs or mTOR inhibitors, or the patient should be enrolled in a clinical trial evaluating CA4P or pazopanib.