PDF(Pubmed)
Abstract：
Pancreatic neuroendocrine tumors (PanNETs) account for approximately 2% of all pancreatic malignancies. Several systemic treatment options have been developed over the last four decades, ranging from cytotoxic chemotherapy and octreotide to newer targeted therapies like sunitinib, cabozantinib, and lenvatinib. Although surgery or liver-directed therapy remains cornerstone for management of metastatic PanNETs, however, they remain unfeasible in majority of cases. PanNETs behave differently than SI-NETs (small intestinal NET); the former is more aggressive and less responsive to somatostatin-based therapies. The optimal sequence of the systemic therapies for the advanced PanNETs depends mainly on the tumor burden, Ki-67 index, and the tempo of the disease. In the end, drawing from ENETS (European Neuroendocrine Tumor Society) and ESMO (European Society for Medical Oncology) guidelines, we propose a working algorithm for the management of advanced PanNETs, not amenable to surgery or liver-directed therapies.
摘要：
胰腺神经内分泌肿瘤（PanNETs）约占所有胰腺恶性肿瘤的2％。在过去的四十年中，已经开发了几种系统治疗方案，从细胞毒性化疗和奥曲肽到舒尼替尼等新型靶向治疗，卡博替尼,还有Lenvatinib.尽管手术或肝定向治疗仍然是转移性PanNETs管理的基石，然而,在大多数情况下，它们仍然不可行。PanNETs的行为与SI-NET（小肠NET）不同；前者更具侵略性，对基于生长抑素的疗法反应较少。针对晚期PanNETs的系统治疗的最佳顺序主要取决于肿瘤负荷。Ki-67指数，和疾病的节奏。最后,来自ENETS（欧洲神经内分泌肿瘤学会）和ESMO（欧洲肿瘤医学学会）指南，我们提出了一种用于管理高级PanNET的工作算法，不适合手术或肝定向治疗。
