Well-to-moderately differentiated
neuroendocrine tumors of gastroesophageal and pancreatic origin (GEP-NETs) with liver
metastasis are a heterogeneous group of
malignancies for which a range of therapeutic options have been employed. Surgical resection of hepatic
metastases or hepatic artery embolization may be beneficial in patients with hepatic-predominant metastatic disease. Patients with "
carcinoid" syndrome and syndromes associated with functional pancreatic NET (
PNET) can be effectively treated with
somatostatin analogs. On the other hand, the efficacy of systemic
chemotherapy for these patients is limited. A placebo-controlled, double-blind, prospective, and randomized study showed that
octreotide LAR improves progression-free survival in patients with advanced midgut functional "
carcinoids." In patients with advanced pancreatic NET, randomized, placebo-controlled studies have recently demonstrated that treatment with the
tyrosine kinase inhibitor sunitinib or with mTOR inhibitor
everolimus is associated with improved progression-free survival. Based on these studies,
octreotide LAR,
sunitinib, or
everolimus are now considered as first-line therapeutic options in patients with advanced NET. Future studies will likely further define the role of these agents in patients with
carcinoid liver
metastasis and pancreatic NET liver
metastasis.