Table 4.
Treatment regimen for GEP NETs and GEP NECs.
| Locoregional/Resectable | Metastatic/Unresectable | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| G1 G2 G3 | G1/G2 | G3 | ||||||||
| Surgery | Asymptomatic/stable | Symptomatic/progressive | NET | NEC | ||||||
| Observe SSA |
Hepatic dominant/metastases | Widespread | Cisplatin/Eotpside Everolimus Sunitinib ** Platinum/Etopside CAP/TEM PRRT SSTR- rapid SSTR+ slow Studies |
Ki-67 50–60% |
Ki-67 >60% |
|||||
| Platinum/Etoposide CAP/TEM FOLFIRI FOLFOX Studies |
Plapinum/Etopside FOLFIRI FOLFOX Studies |
|||||||||
| Chemoembolization STZ |
panNET | Midgut NET | ||||||||
| SSTR+ | SSTR+ Ki-67 >10% | SSTR- | SSTR+ | SSTR- | ||||||
| Everolimus Studies Sunitinib Lanreotide SSA PRRT |
STZ/FU CAP/TEM * |
Everolimus Studies Sunitinib STZ/FU CAP/TEM |
Everolimus IFN alpha Studies Octreotide Lanreotide SSA PRRT |
Everolimus IFN alpha Studies |
||||||
* STZ/FU, CAP/TEM- if progression occurs after treatment, continue treatment as recommended for SSTR+, except for the use of SSA. ** Sunitinib only for PanNET. CAP: capecitabine; Ki-67: rate of cell growth; TEM: temozolomide; FOLFIRI: treatment regimen that includes folinic acid, fluorouracil and irinotecan hydrochloride; FOLFOX: treatment regimen that includes folinic acid, fluorouracil and oxaliplatin, FU: fluorouracil; PRRT: peptide receptor radionuclide therapy; SSA: somatostatin analogs; SSTR: somatostatin receptor; STZ: streptozocin.