Figure 22.

Diagram demonstrating the sites and mechanism of action of novel agents for the management of pancreatic endocrine neoplasm. The growth factor receptors when occupied by their respective growth factors (in an autocrine or paracrine manner) lead to autophosphorylation of the intracellular tyrosine kinase component of the receptor. This activates the mammalian target of rapamycin (mTOR) pathway (among others), ultimately promoting protein synthesis, cell cycle progression and cell survival. The pathway can be inhibited by monoclonal antibodies to growth factor receptors, tyrosine kinase inhibitors or downstream mTOR inhibitors.