Review article: future therapies for management of metastatic gastroenteropancreatic neuroendocrine tumours.
BACKGROUND
Gastroenteropancreatic neuroendocrine tumours (GEP NETs) are relatively uncommon tumours that occur anywhere within the gastrointestinal tract. The prevalence of GEP NETs is estimated to be 35 per 100 000 population. Patients often present with metastatic disease and consequently, palliative treatments form the mainstay of therapy.


OBJECTIVE
To review the current and novel therapeutic options for management of GEP NETs.


METHODS
Searches for all studies related to GEP NETs, NETs and carcinoid tumours in Medline and abstracts from international meetings.


RESULTS
Somatostatin analogues remain the first line therapy for management of symptoms of GEP NETs and may have anti-proliferative action. New somatostatin analogues with different somatostatin receptor affinity have been developed. Radionuclide peptide receptor therapy is established in patients with positive somatostatin scintigraphy. A number of new agents and targeted therapies are currently being evaluated in a phase I and II studies and these include angiogenic inhibitors, mammalian target of rapamycin inhibitors and immune therapies.


CONCLUSIONS
A number of nonsurgical therapies are available for management of gastroenteropancreatic neuroendocrine tumours. It is hoped, the development of some of these promising novel therapies will expand the therapeutic armamentarium.
Srirajaskanthan
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R
Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK. m.caplin@medsch.ucl.ac.uk
Toumpanakis
C
C
Meyer
T
T
Caplin
M E
ME
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D009362:Neoplasm Metastasis / Q000628:therapy; D018358:Neuroendocrine Tumors / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000628:therapy; D018000:Receptors, Peptide / Q000627:therapeutic use*; D017481:Receptors, Somatostatin / Q000627:therapeutic use*
D020533:Angiogenesis Inhibitors; D018906:Antineoplastic Agents, Alkylating; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D018000:Receptors, Peptide; D017481:Receptors, Somatostatin