title: Emerging therapeutic options for advanced enteropancreatic neuroendocrine tumors.
abstract: BACKGROUND
  Several chemotherapy agents and combinations have proven effective in the therapy of advanced enteropancreatic neuroendocrine tumors (EP-NETs). However, their toxicity can be significant. Recent understanding of the molecular mechanisms of these tumors, especially the central role of tumor angiogenesis, has led to the identification of new therapeutic targets and agents directed at the molecular level.
  
  
  METHODS
  This paper gives a comprehensive evaluation of the existing therapeutic armamentarium for EP-NETs. Narrated in a historical perspective, this review analyzes the available information on traditional chemotherapy agents, interferon-α and somatostatin analogs, as well as newer therapies and experimental agents.
  
  
  CONCLUSIONS
  Despite recent advances, a curative approach for metastatic EP-NETs is yet to be discovered. To date, sunitinib and everolimus have been shown to impact progression-free survival only in pancreatic NETs, and the duration of this benefit has not yet been established. Further research is necessary to determine whether a combination of these drugs, either together or with other therapies, may yield superior outcomes. Moreover, sequential use of these agents should be explored in an attempt to improve survival. Efficacy of a variety of experimental agents is also being tested in clinical trials.
authors.affiliation: Department of Hematology-Oncology, St. Francis Hospital and Medical Center, Hartford, CT 06105, USA. c_dasanu@yahoo.com
authors.forename: Constantin A
authors.initials: CA
authors.lastname: Dasanu
authors.forename: Shounak
authors.initials: S
authors.lastname: Majumder
authors.forename: Srila
authors.initials: S
authors.lastname: Gopal
authors.forename: Elena
authors.initials: E
authors.lastname: Stoica-Mustafa
authors.forename: Guru
authors.initials: G
authors.lastname: Trikudanathan
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004067:Digestive System Neoplasms / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D018358:Neuroendocrine Tumors / Q000188:drug therapy*; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D016898:Interferon-alpha; D013004:Somatostatin