title: Therapeutic management of patients with gastroenteropancreatic neuroendocrine tumours.
abstract: Patients with neuroendocrine tumours (NETs) are best managed in a specialist centre as part of a multidisciplinary team comprising gastroenterologists, oncologists, endocrinologists, gastrointestinal and hepatopancreaticobiliary surgeons, pathologists, nuclear medicine physicians and technicians, radiologists, specialist nurses, pharmacists, biochemists and dieticians. This should ideally be led by a clinician with experience and interest in NETs. Although the number of medical treatments and clinical trials has increased in the decade, there is still a lack of prospective randomised trials; thus, management is mainly based on limited often single-centre studies, although there are now formal guidelines based on consensus expert opinion. We have outlined the current optimal management of patients with NETs. We have reviewed therapeutic options including surgery, somatostatin analogues and other biotherapies and peptide receptor-targeted therapy. We have discussed the challenge in managing hepatic metastases including hepatic artery embolisation, ablation and orthotopic liver transplant. In addition, we have briefly reviewed the emerging therapies such as the mammalian target of rapamycin and angiogenic inhibitors and the newer somatostatin analogues.
authors: Neuroendocrine Tumour Unit, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, UK.
authors: Mohid S
authors: MS
authors: Khan
authors: Martyn E
authors: ME
authors: Caplin
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005770:Gastrointestinal Neoplasms / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D018358:Neuroendocrine Tumors / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000628:therapy*; D011868:Radioisotopes / Q000627:therapeutic use; D018000:Receptors, Peptide / Q000378:metabolism; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D011868:Radioisotopes; D018000:Receptors, Peptide; D013004:Somatostatin; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases