Systemic Therapy for well and Moderately Differentiated Unresectable Pancreatic Neuroendocrine Tumours

Following are some important recommendations from the guidelines for Systemic Therapy for well and Moderately Differentiated Unresectable Pancreatic Neuroendocrine Tumours based on the article by Alberta Provincial Endocrine Tumour Team issued in Feb 2015



The choice and sequence of systemic therapy treatment is determined by patient factors, tumour factors, potential therapy related adverse events, and patient preferences, as assessed by the treating oncologist. If available and patient is eligible, consider treatment on a clinical trial or referral to a specialized centre for consideration for radionuclide therapy.

1. Sunitinib malate has been shown to prolong progression free survival (versus placebo) in patients with well differentiated unresectable pancreatic neuroendocrine tumours (PNETs).
   
   
   
   1. Sunitinib malate is recommended for progressive, well and moderately differentiated PNETs in adults with unresectable locally advanced or metastatic disease.
   
   
   2. Sunitinib malate should be given at a dose of 37.5 mg, orally, once daily, with or without food, continuously without a scheduled off-treatment period.
   
   
   
   


2. Everolimus has been shown to prolong progression free survival (versus placebo) in patients with unresectable, well or moderately differentiated PNETs.
   
   
   
   1. Everolimus is recommended for unresectable or metastatic, well or moderately differentiated neuroendocrine tumours of pancreatic origin in adults with progressive disease.
   
   
   2. Everolimus should be given at a dose of 10 mg, orally, once daily. Treatment should continue as long as clinical benefit is observed or until unacceptable toxicity occurs.
   
   
   
   


3. Capecitabine and temozolomide in combination has not been compared to placebo, however, a potential for clinical benefit is suggested from a recently presented phase II study.
   
   
   
   1. Capecitabine and temozolomide in combination is a reasonable option for consideration in treatment of patients with unresectable or metastatic PNETs.