Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.
Cancer Control. 2011 Apr;18(2):127-37. doi: 10.1177/107327481101800207.
Treatment options for metastatic gastroenteropancreatic neuroendocrine tumors (NETs) have evolved in recent years. The somatostatin analogs octreotide and lanreotide have long been used for management of symptoms such as flushing and diarrhea associated with hormonally active NETs. New evidence demonstrates that these agents can also inhibit tumor growth. Other novel agents targeting the VEGF and mTOR pathways have recently been investigated in multicenter phase III studies.
The authors review the recent literature on treatments for metastatic gastroenteropancreatic NETs and summarize new therapeutic developments.
Novel agents targeting somatostatin receptors and the VEGF and mTOR pathways are capable of significantly prolonging progression-free survival in certain NET subtypes. New temozolomide-based chemotherapy regimens have demonstrated considerable activity in pancreatic NETs. Liver-targeted therapies, including surgical resection, radiofrequency ablation, and hepatic artery embolization, are effective options for patients whose metastases are predominantly confined to the liver. Embolization of (90)Y-embedded spheres (radioembolization) represents a novel approach to managing liver metastases.
Treatment options are expanding rapidly for patients with metastatic gastroenteropancreatic NETs, driven largely by randomized, collaborative clinical trials. Future clinical trials should compare the efficacy of emerging therapies and evaluate combination vs sequential approaches.
近年来，转移性胃肠胰腺神经内分泌肿瘤（NET）的治疗选择已经发生了变化。生长抑素类似物奥曲肽和兰瑞肽长期以来一直用于治疗与激素活性 NET 相关的潮红和腹泻等症状。新的证据表明，这些药物也可以抑制肿瘤生长。最近，针对 VEGF 和 mTOR 途径的其他新型药物也在多中心 III 期研究中进行了研究。
作者回顾了转移性胃肠胰腺 NET 治疗的最新文献，并总结了新的治疗进展。
针对生长抑素受体以及 VEGF 和 mTOR 途径的新型药物能够显著延长某些 NET 亚型的无进展生存期。新的基于替莫唑胺的化疗方案在胰腺 NET 中显示出相当大的活性。针对转移主要局限于肝脏的患者，肝靶向治疗（包括手术切除、射频消融和肝动脉栓塞）是有效的选择。（90）Y 嵌入球体栓塞（放射性栓塞）是一种治疗肝转移的新方法。
转移性胃肠胰腺 NET 患者的治疗选择正在迅速扩大，这主要是由随机、协作的临床试验推动的。未来的临床试验应比较新兴疗法的疗效，并评估联合与序贯方法。
