Optimal strategy of systemic treatment for unresectable pancreatic neuroendocrine tumors based upon opinion of Japanese experts.

Abstract

BACKGROUND/OBJECTIVES:

A number of therapeutic agents have been reported to be clinically useful for the management of the patients with unresectable pancreatic neuroendocrine tumors (PanNETs) including somatostatin analogues, molecular-targeted agents and cytotoxic agents. However, the optimal strategy for selection among those treatment modalities above in these patients has remained unexplored.

METHODS:

Japanese experts for PanNET discussed and determined the optimal treatment strategies according to the results of previously reported studies.

RESULTS:

The tumor volume of liver metastases and the Ki-67 labeling index were unanimously accepted as indicators of the tumor burden and tumor aggressiveness, respectively, which are two most clinically pivotal factors for determining the strategy of systemic treatment for unresectable PanNETs. In addition, for those with a relatively small tumor burden and slow disease progression, somatostatin analogues were selected as the first-line treatment agents. For those with a relatively large tumor burden and rapid tumor progression, cytotoxic agents were selected, possibly aiming at tumor shrinkage. For those of intermediate tumor volume and/or growth rate, molecular-targeted agents were selected as the first choice. Based on this strategy discussed among the experts, we tentatively prepared a MAP for proposing optimal treatment strategy and examined its validity in some patients with unresectable PanNETs. Results validated the usefulness of this MAP proposed for patients harbouring unresectable PanNETs.

CONCLUSION:

We herein propose a tentative MAP for optimal treatment selection for the patients harbouring unresectable PanNETs. Further large scale studies are, however, warranted to validate the usefulness of this MAP proposed in this study.

• Authors: Masafumi Ikeda, Chigusa Morizane, Susumu Hijioka, Shigemi Matsumoto, Tsuyoshi Konishi, Izumi Komoto, Taku Aoki, Tetsuhide Ito, Junji Furuse, Hironobu Sasano, Ryuichiro Doi
• Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] (Pancreatology) Vol. 20 Issue 5 Pg. 944-950 (Jul 2020) ISSN: 1424-3911 [Electronic] Switzerland
• PMID: 32565093 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Chemical References

• Antineoplastic Agents
• Antineoplastic Agents, Hormonal
• Ki-67 Antigen
• Somatostatin

Topics

• Aged
• Antineoplastic Agents (therapeutic use)
• Antineoplastic Agents, Hormonal (therapeutic use)
• Disease Management
• Disease Progression
• Female
• Humans
• Japan
• Ki-67 Antigen
• Liver Neoplasms (pathology, secondary)
• Male
• Middle Aged
• Neuroendocrine Tumors (diagnostic imaging, therapy)
• Pancreatic Neoplasms (diagnostic imaging, therapy)
• Somatostatin (analogs & derivatives, therapeutic use)
• Survival Analysis
• Tomography, X-Ray Computed
• Tumor Burden