Journal article
Systemic Therapy for Tumor Control in Metastatic Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline
Journal of clinical oncology, Vol.41(32), pp.5049-5067
11/10/2023
DOI: 10.1200/JCO.23.01529
PMID: 37774329
Abstract
PURPOSE To develop recommendations for systemic therapy for well-differentiated grade 1 (G1) to grade 3 (G3) metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs). METHODS ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eight randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS Somatostatin analogs (SSAs) are recommended as first-line systemic therapy for most patients with G1-grade 2 (G2) metastatic well-differentiated GI-NETs. Observation is an option for patients with low-volume or slow-growing disease without symptoms. After progression on SSAs, peptide receptor radionuclide therapy (PRRT) is recommended as systematic therapy for patients with somatostatin receptor (SSTR)–positive tumors. Everolimus is an alternative second-line therapy, particularly in nonfunctioning NETs and patients with SSTR-negative tumors. SSAs are standard first-line therapy for SSTR-positive pancreatic (pan)NETs. Rarely, observation may be appropriate for asymptomatic patients until progression. Second-line systemic options for panNETs include PRRT (for SSTR-positive tumors), cytotoxic chemotherapy, everolimus, or sunitinib. For SSTR-negative tumors, first-line therapy options are chemotherapy, everolimus, or sunitinib. There are insufficient data to recommend particular sequencing of therapies. Patients with G1-G2 high-volume disease, relatively high Ki-67 index, and/or symptoms related to tumor growth may benefit from early cytotoxic chemotherapy. For G3 GEP-NETs, systemic options for G1-G2 may be considered, although cytotoxic chemotherapy is likely the most effective option for patients with tumor-related symptoms, and SSAs are relatively ineffective. Qualifying statements are provided to assist with treatment choice. Multidisciplinary team management is recommended, along with shared decision making with patients, incorporating their values and preferences, potential benefits and harms, and other characteristics and circumstances, such as comorbidities, performance status, geographic location, and access to care. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .
Details
- Title: Subtitle
- Systemic Therapy for Tumor Control in Metastatic Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline
- Creators
- Jaydira Del Rivero - National Cancer InstituteKimberly Perez - Dana-Farber Cancer InstituteErin B. Kennedy - American Society of Clinical OncologyErik S. Mittra - Oregon Health & Science UniversityNamrata Vijayvergia - Fox Chase Cancer CenterJuniad Arshad - University of ArizonaSandip Basu - Tata Memorial HospitalAman Chauhan - University of Miami Health SystemArvind N. Dasari - The University of Texas MD Anderson Cancer CenterAndrew M. Bellizzi - University of IowaAlexandra Gangi - Cedars-Sinai Medical CenterErin Grady - Stanford MedicineJames R. Howe - University of IowaJana Ivanidze - Cornell UniversityMark Lewis - Intermountain HealthcareJosh Mailman - NorCal CarciNET Community, Oakland, CANitya Raj - Memorial Sloan Kettering Cancer CenterHeloisa P. Soares - University of UtahMichael C. Soulen - Penn Center for AIDS ResearchSarah B. White - Medical College of WisconsinJennifer A. Chan - Dana-Farber Cancer InstitutePamela L. Kunz - Yale UniversitySimron Singh - Sunnybrook Health Science CentreThorvardur R. Halfdanarson - Mayo Clinic in ArizonaJonathan R. Strosberg - Moffitt Cancer CenterEmily K. Bergsland - University of California, San Francisco
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.41(32), pp.5049-5067
- DOI
- 10.1200/JCO.23.01529
- PMID
- 37774329
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Electronic publication date
- 09/29/2023
- Date published
- 11/10/2023
- Academic Unit
- Pathology; Surgery
- Record Identifier
- 9984473759402771
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