Evolving Understanding of Neuroendocrine Tumors

Evolution of Neuroendocrine Tumor Understanding and Treatment

The prevalence of NETs has dramatically increased over the past 3 to 4 decades, with current prevalence approaching 200,000 patients and an incidence of approximately 5 to 6 per 100,000 people. These patients now live significantly longer than in previous decades, making NETs no longer considered a rare disease. The survival improvements have been remarkable, with patients previously living only a few years now predictably surviving 8 to 9 years or more, sometimes well beyond 10 years.

Treatment advances have been revolutionary since the late 1980s, when only single-agent somatostatin analogs were available. The evolution progressed from daily subcutaneous injections to depot formulations, and from 1 product (octreotide) to additional options like lanreotide. The introduction of targeted therapies has fundamentally changed the treatment landscape, providing clinicians with multiple therapeutic options that significantly impact patient outcomes.

The rising incidence and prevalence has necessitated improved diagnostic strategies and more targeted workup approaches. Clinicians now categorize tumors based on their biology, with indolent diseases like gastric NETs requiring different workup intensity compared with more aggressive variants in the duodenal-jejunal-ileal region. Resource allocation has become more strategic, with diagnostic tools like CT scans and DOTA PET scans being applied based on pathological findings and tumor characteristics.