title: New therapeutic options for metastatic malignant insulinomas.
abstract: Insulinomas are the most common, functioning, pancreatic neuroendocrine tumours. The great majority (>90%) of insulinomas are nonmetastatic at presentation and can be surgically cured. The <10% patients with distant (liver-bone) metastases have a median survival of < 2 years. Everolimus and sunitinib have been recently introduced as targeted therapies for metastatic pancreatic neuroendocrine tumours. An additional advantage of everolimus in the treatment of patients with metastatic insulinomas is its capability to increase blood glucose levels. Peptide receptor radiotherapy using radiolabelled somatostatin analogues has also been shown to be successful in controlling tumour growth of metastatic pancreatic neuroendocrine tumours. In patients with metastatic insulinomas, this therapeutic modality was also effective in controlling hypoglycaemia, even in the presence of tumour regrowth. With the introduction of these new therapeutic modalities, the therapeutic arsenal for the 'tailor-made' approach of patients with metastatic insulinomas is further expanded.
authors.affiliation: Department of Internal Medicine, Sector of Endocrinology, Erasmus MC, Rotterdam, the Netherlands. w.w.deherder@erasmusmc.nl
authors.forename: Wouter W
authors.initials: WW
authors.lastname: de Herder
authors.forename: Ellen
authors.initials: E
authors.lastname: van Schaik
authors.forename: Dik
authors.initials: D
authors.lastname: Kwekkeboom
authors.forename: Richard A
authors.initials: RA
authors.lastname: Feelders
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068338:Everolimus; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007340:Insulinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D008113:Liver Neoplasms / Q000517:prevention & control / Q000556:secondary; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D011758:Pyrroles / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D017481:Receptors, Somatostatin / Q000378:metabolism; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; D013004:Somatostatin; D000068338:Everolimus; D000077210:Sunitinib; D020123:Sirolimus