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Endocrine Abstracts (2022) 81 S18.1 | DOI: 10.1530/endoabs.81.S18.1

ECE2022 Symposia Unmet needs in aggressive endocrine cancers (3 abstracts)

Choosing the best treatment sequence for gepnet tumours

Eva Tiensuu Janson


Department of Medical Sciences, Uppsala University, Uppsala, Sweden


Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are grouped according to the origin of the primary tumor and their proliferation index (Ki-67). The WHO classification divide GEP-NETs into G1 (Ki-67 <3%), G2 (Ki-67 ≥3-20%) and G3 (Ki-67 >20%). Both parameters are accounted for when treatment strategies are planned. Furthermore, the presence of hormone related symptoms warrant consideration.

Aim: To describe the treatment landscape for metastasized GEP-NETs.

Results/discussion: Surgery should always be discussed and performed if R0 is considered possible. Most GEP-NETs express somatostatin receptors (SSRs) and treatment with somatostatin analogs is the primary choice in metastatic low proliferating GEP-NETs, originating both in the small intestine and pancreas, and to reduce symptoms of carcinoid syndrome or in the rare event of a glucagonoma or VIPoma. SSR expression is also a prerequisite for peptide receptor radionuclide therapy (PRRT) which is usually recommended as second or third line treatment in both G1 and G2 tumors and for a selected population of GEP-NET G3. For patients with pancreatic tumors with Ki-67 >10%, chemotherapy or the mTOR inhibitor everolimus may be used as first line treatment. Everolimus may also be an option in progressing small intestinal NETs with a higher proliferation rate. Sunitinib is an alternative in progressing PanNETs. To reduce tumor burden in the liver, radiofrequency ablation or liver embolization may be used. In rare cases, liver transplantation may also be discussed, but a thorough preoperative work-up has to be performed before such an intervention is initiated. For those patients that does not respond to the traditional therapies, treatment in clinical studies can be an option.

Conclusion: The therapeutic landscape for metastasized GEP-NETs include several treatment options. However, the sequencing of therapy is still debated and choices should be made in order to preserve QoL and minimize the risk for severe side effects.

Volume 81

European Congress of Endocrinology 2022

Milan, Italy
21 May 2022 - 24 May 2022

European Society of Endocrinology 

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