Chemotherapy for Neuroendocrine Tumors

Chemotherapy is the cornerstone of therapy for poorly differentiated pancreatic neuroendocrine tumors (pNETs), says Jonathan R. Strosberg, MD. First-line treatment combinations for poorly differentiated pNETs include a platinum-based therapy with etoposide, FOLFOX (fluorouracil, leucovorin, and oxaliplatin), or FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin).

Streptozotocin-based combinations, such as streptozotocin and fluorouracil or streptozotocin and doxorubicin, have been used to treat well-differentiated NETs, says Strosberg. Temozolomide-based regimens are also commonly utilized in this setting due to high response rates and good tolerability.

Chemotherapy is a potential option in patients who have bulky disease or those with widely metastatic tumors, notes James C. Yao, MD. Following progression on prior therapy, including targeted agents, such as everolimus or sunitinib, patients may also receive chemotherapy, he adds.

Chemotherapy has been used in patients with metastatic NETs and appears to be more effective in pancreatic disease compared with carcinoid tumors, states Matthew H. Kulke, MD. Response to chemotherapy is typically seen within the first 3 to 4 months of treatment for patients with pNETs, explains Kulke. Chemotherapy is often continued for a longer duration of time in patients who are responding to treatment or who have stable disease.