Masafumi Ikeda1, Chigusa Morizane2, Susumu Hijioka2, Shigemi Matsumoto3, Tsuyoshi Konishi4, Izumi Komoto5, Taku Aoki6, Tetsuhide Ito7, Junji Furuse8, Hironobu Sasano9, Ryuichiro Doi10. 1. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan. Electronic address: masikeda@east.ncc.go.jp. 2. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan. 3. Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan. 5. Department of Surgery, Kansai Electric Power Hospital, Osaka, Japan. 6. Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan. 7. Neuroendocrine Tumor Center, Fukuoka Sanno Hospital, Internal University of Health and Welfare, Fukuoka, Japan. 8. Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan. 9. Department of Pathology, Tohoku University School of Medicine, Sendai, Japan. 10. Department of Surgery, Otsu Red Cross Hospital, Otsu, Japan.
Abstract
BACKGROUND/ OBJECTIVES: A number of therapeutic agents have been reported to be clinically useful for the management of the patients with unresectable pancreatic neuroendocrine tumors (PanNETs) including somatostatin analogues, molecular-targeted agents and cytotoxic agents. However, the optimal strategy for selection among those treatment modalities above in these patients has remained unexplored. METHODS: Japanese experts for PanNET discussed and determined the optimal treatment strategies according to the results of previously reported studies. RESULTS: The tumor volume of liver metastases and the Ki-67 labeling index were unanimously accepted as indicators of the tumor burden and tumor aggressiveness, respectively, which are two most clinically pivotal factors for determining the strategy of systemic treatment for unresectable PanNETs. In addition, for those with a relatively small tumor burden and slow disease progression, somatostatin analogues were selected as the first-line treatment agents. For those with a relatively large tumor burden and rapid tumor progression, cytotoxic agents were selected, possibly aiming at tumor shrinkage. For those of intermediate tumor volume and/or growth rate, molecular-targeted agents were selected as the first choice. Based on this strategy discussed among the experts, we tentatively prepared a MAP for proposing optimal treatment strategy and examined its validity in some patients with unresectable PanNETs. Results validated the usefulness of this MAP proposed for patients harbouring unresectable PanNETs. CONCLUSION: We herein propose a tentative MAP for optimal treatment selection for the patients harbouring unresectable PanNETs. Further large scale studies are, however, warranted to validate the usefulness of this MAP proposed in this study.
BACKGROUND/ OBJECTIVES: A number of therapeutic agents have been reported to be clinically useful for the management of the patients with unresectable pancreatic neuroendocrine tumors (PanNETs) including somatostatin analogues, molecular-targeted agents and cytotoxic agents. However, the optimal strategy for selection among those treatment modalities above in these patients has remained unexplored. METHODS: Japanese experts for PanNET discussed and determined the optimal treatment strategies according to the results of previously reported studies. RESULTS: The tumor volume of liver metastases and the Ki-67 labeling index were unanimously accepted as indicators of the tumor burden and tumor aggressiveness, respectively, which are two most clinically pivotal factors for determining the strategy of systemic treatment for unresectable PanNETs. In addition, for those with a relatively small tumor burden and slow disease progression, somatostatin analogues were selected as the first-line treatment agents. For those with a relatively large tumor burden and rapid tumor progression, cytotoxic agents were selected, possibly aiming at tumor shrinkage. For those of intermediate tumor volume and/or growth rate, molecular-targeted agents were selected as the first choice. Based on this strategy discussed among the experts, we tentatively prepared a MAP for proposing optimal treatment strategy and examined its validity in some patients with unresectable PanNETs. Results validated the usefulness of this MAP proposed for patients harbouring unresectable PanNETs. CONCLUSION: We herein propose a tentative MAP for optimal treatment selection for the patients harbouring unresectable PanNETs. Further large scale studies are, however, warranted to validate the usefulness of this MAP proposed in this study.