title: Selecting patients for cytotoxic therapies in gastroenteropancreatic neuroendocrine tumours.
abstract: Gastroenteropancreatic neuroendocrine tumours (GEP-NET) have heterogenic clinical presentations. The majority of GEP-NET tumours have an indolent behaviour, but patients will eventually develop symptoms of tumour progression or hormone secretion that may require systemic medical interventions. Cytotoxic chemotherapy has been tested in GEP-NETs since the 80s, but treatment recommendations are controversial in many instances. Patient selection is mandatory for optimal use of chemotherapy. Important prognostic factors such as primary tumour site, tumour differentiation, tumour staging and proliferation index have been identified and validated in retrospective and prospective series. The combination of those factors and the natural history of GEP-NET provide valuable information with respect to treatment planning. In this report we provide treatment recommendations to improve systemic therapy in patients with advanced GEP-NETs based on a comprehensive review of the literature.
authors.affiliation: Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet 90, São Paulo, SP, CEP 01308-050, Brazil. fredericoperegocosta@gmail.com
authors.forename: F P
authors.initials: FP
authors.lastname: Costa
authors.forename: B
authors.initials: B
authors.lastname: Gumz
authors.forename: B
authors.initials: B
authors.lastname: Pasche
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000069287:Capecitabine; D049109:Cell Proliferation; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007414:Intestinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000188:drug therapy* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018579:Patient Selection; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013311:Streptozocin / Q000627:therapeutic use; D000077204:Temozolomide
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D013311:Streptozocin; D000069287:Capecitabine; D003606:Dacarbazine; D005472:Fluorouracil; D000077204:Temozolomide