Multidisciplinary Treatment of Pancreatic Neuroendocrine Tumors - Episode 2

Newly Diagnosed Pancreatic Neuroendocrine Tumors

Gaining a better understanding of the biology of pancreatic neuroendocrine tumors (NETs) has led to certain treatment changes, states Diane Reidy-Lagunes, MD. Streptozotocin was historically used in the management of pancreatic NETs but was toxic, says Lagunes. However, the introduction of somatostatin analogs dramatically improved the treatment options available for patients with functional syndromes, notes Lagunes.

Octreotide and lanreotide are somatostatin analogs that may be used to treat VIPoma and other functional syndromes. Targeted therapies, such as the VEGF TKI sunitinib and the mTOR inhibitor everolimus are available to treat patients with high tumor burden, as are other cytotoxic therapies. However, optimal use of these therapies remains unclear, states Lagunes.

Octreoscans and gallium-68 scans are important tools to utilize when determining the extent of disease, comments J. Philip Boudreaux, MD. Endoscopic ultrasound is beneficial in evaluating and visualizing node status and tumor proximity to vascular and biliary structures in the head and body of the pancreas, adds Boudreaux; however, this approach falls short in visualizing the tail of the pancreas. Boudreaux’s practice utilizes biologic markers, such as insulin, pro-insulin, glucagon, vasoactive intestinal polypeptide, and gastrin, to help monitor biologic activity. Changes that are detected may indicate that it is time to reimage, says Boudreaux.

Utilizing a particular functional marker is appropriate when treating a functional tumor, explain Rodney Pommier, MD, and Pamela L. Kunz, MD. If individuals have elevated sugar, it may be appropriate to check glucagon; if sugars are low, then insulin and pro-insulin may be monitored. Looking at a panel of markers at the beginning of a patient’s treatment may be useful so that they can be monitored over time. These biomarkers are not prognostic, notes Kunz, but are useful to trend patients’ responses to treatments.