title: Personalized treatment approach to gastroenteropancreatic neuroendocrine tumors: a medical oncologist's perspective.
abstract: The medical management of gastroenteropancreatic neuroendocrine tumors involves treatment of symptomatic disease related to hormone secretions or bulky unresectable metastatic disease. Combining gallium DOTA with fluorine-18 fluorodeoxyglucose-PET along with histopathological grading helps to determine tumor heterogeneity and seek reasons for poor response to therapy. In the light of adding chemotherapy in selected patients with intermediate-grade tumors, the newer scan helps in personalization of the therapy along with the biopsy. The tumor dedifferentiation over the particular time period leading to aggressive behavior, a well-known entity, is contrasted with the redifferentiation phenomenon in some patients as a result of chemotherapy or targeted drug therapy. This may support the basis for combining peptide receptor-targeted radiotherapy/octreotide therapy with chemotherapy or mTOR inhibitors such as everolimus.
authors.affiliation: aDepartment of Medical Oncology, Tata Memorial Hospital bRadiation Medicine Centre, Mumbai, India.
authors.forename: Davinder
authors.initials: D
authors.lastname: Paul
authors.forename: Vikas
authors.initials: V
authors.lastname: Ostwal
authors.forename: Subhadeep
authors.initials: S
authors.lastname: Bose
authors.forename: Sandip
authors.initials: S
authors.lastname: Basu
authors.forename: Sudeep
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D001706:Biopsy; D018278:Carcinoma, Neuroendocrine / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D002454:Cell Differentiation / Q000187:drug effects; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D058990:Molecular Targeted Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D000072103:Oncologists; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D018579:Patient Selection; D010641:Phenotype; D057285:Precision Medicine; D011237:Predictive Value of Tests; D015398:Signal Transduction / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor