Division of Solid Tumor Oncology, Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Weill College of Medicine, Cornell University, New York, NY, USA.
J Natl Compr Canc Netw. 2012 Jun 1;10(6):777-83. doi: 10.6004/jnccn.2012.0077.
Well-differentiated neuroendocrine tumors (NETs) can be subdivided into carcinoid and pancreatic NETs (pancNETs). Although these tumors share many morphologic and clinical characteristics, carcinoid tumors appear to be far less sensitive to therapeutic agents than pancNETs, and recent advances approved for pancNETs have not been submitted for FDA approval in patients with carcinoid tumors. Treatment options for patients with advanced pancNETs are multidisciplinary and include surgical resection, liver-directed therapies, and systemic therapies. Cytotoxic therapies, such as temozolomide, fluorouracil, oxaliplatin, and streptozocin-based chemotherapy regimens, are active against some pancNETs, and can play a role in the palliation of patients with advanced disease and symptoms related to tumor bulk. Two therapies were recently approved for progressive well-differentiated pancNETs: sunitinib and everolimus. Both agents showed improved progression-free survival in patients with progressive pancNETs, but can also result in nontrivial toxicities, and therefore should only be considered in patients with progressing and advanced or symptomatic disease. This article discusses these recent trials and provides an update of systemic treatment options in patients with well-differentiated pancNETs.
分化良好的神经内分泌肿瘤 (NET) 可进一步细分为类癌和胰腺神经内分泌肿瘤 (pancNET)。尽管这些肿瘤具有许多形态学和临床特征，但类癌似乎对治疗药物的敏感性远低于 pancNET，并且最近批准用于 pancNET 的进展并未提交给 FDA 用于批准类癌患者。晚期 pancNET 患者的治疗选择是多学科的，包括手术切除、肝定向治疗和全身治疗。细胞毒性疗法，如替莫唑胺、氟尿嘧啶、奥沙利铂和链脲佐菌素为基础的化疗方案，对一些 pancNET 有效，并可在缓解晚期疾病和与肿瘤体积相关的症状方面发挥作用。最近有两种疗法被批准用于进展性分化良好的 pancNET：舒尼替尼和依维莫司。这两种药物都显示出在进展性 pancNET 患者中无进展生存期的改善，但也可能导致相当大的毒性，因此仅应在进展和晚期或有症状的疾病患者中考虑使用。本文讨论了这些最近的试验，并提供了更新的分化良好的 pancNET 患者的全身治疗选择。
