Effective Sequencing of Treatments for pNETs - Episode 9

Case Study: Treating Metastatic Pancreatic NETs

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Moderator, Matthew H. Kulke, MD, introduces are case-based discussion in which a patient presents with a kidney stone. Following a CT scan, the patient is incidentally found to have some spots in the liver and a mass in the tail of the pancreas. Following a biopsy, the patient was diagnosed with a well-differentiated neuroendocrine tumor (NET).

At this point, Rodney F. Pommier, MD, believes that it is important to determine whether the patient has a genetic syndrome, such as multiple endocrine neoplasia type 1, and also to investigate whether other family members might be affected. For this patient, a combination of major liver surgery and pancreatic surgery might be too much surgery in one setting for the patient, Pommier believes.

In a patient who has an unresectable asymptomatic pancreatic NET it is important to confirm that the somatostatin receptor positive status is present, notes Diane Reidy-Lagunes, MD, MS. Watchful waiting is a reasonable approach for a patient that truly is asymptomatic. However, in a patient with more advanced disease, a somatostatin analog might be appropriate. It is important to have these discussions with the patient, she added.

Jonathan R. Strosberg, MD, also believes the best options in this scenario are observation or treatment with a somatostatin analog. These approaches are the least risky and the least toxic. However, for patients with high volume symptomatic disease, cytotoxic chemotherapy may be appropriate, Strosberg believes.