Endocrine Abstracts

Enteropancreatic neuroendocrine (EP-NET) tumours consist of a wide range of malignancies initially thought to be rare. The incidence of this disease has increased dramatically in the last three decades, possibly due to advancements in imaging techniques and a better understanding of the tumour’s natural history. Based on clinical trial results, various therapeutic options have emerged, including somatostatin analogue, molecular targeted therapy, cytotoxic agents, and surgery. This systematic review studied EP-NETS’s evolution and natural history, explored current diagnostic and treatment modalities with a special focus on morbidity and mortality, and critically appraised available evidence to recommend future research. A qualitative systematic review was conducted using MEDLINE and Google Scholar studies, and the results were presented in a narrative format using tables and figures. The review critically explores the issues that must be elucidated and highlights existing controversies regarding the currently established therapeutic approach. It also explores potential treatment areas for these tumours to improve overall survival in the near future. Currently, the ENETS and other neuroendocrine expert bodies recommend monotherapy with somatostatin analogue with a switch to molecular therapy (Peptide receptor radionuclide therapy) if there is disease progression; it is suggested that a more aggressive combination systemic therapy should be explored to achieve a better outcome (for instance, combination with everolimus, which has superiority for advanced NETs). There is no data exploring the role of adjuvant chemotherapy in individuals who had curative surgery and are at high risk of relapse. The last decade has witnessed a rapid improvement in the therapeutic options available for patients with EP-NETs; however, the criteria for defining these treatment modalities with regard to timing, sequence, and priority of use are largely debated. More RCTs comparing active agents rather than placebo, and consequently, additional data on the appropriate sequencing of treatments, will lead to better patient outcomes.