Treating GEP-NETs

The treatment you receive will depend on multiple factors, including1,2

Location: Where the tumor is
Characteristics of the tumor: The size of the tumor and how fast it’s growing
Extension of the tumor: If the tumor has spread to other parts of the body (metastasized)
General body function: The functioning of other parts of the body, such as the liver and kidneys, will be assessed
General health: Your overall health and wellbeing
Multidisciplinary advice: The advice given by the clinical team involved in treating the tumor
Personal preference: Your goals and objectives for treatment will be considered alongside the other factors

Surgery

When planning treatment, surgery is usually one of the first options to help remove the tumor as a potential cure in the early stages of the cancer, or to reduce the tumor size and burden. In many cases the tumor can’t be removed completely, but surgery may help to reduce the size of the tumor and help to manage any symptoms.1

Due to the nature of GEP-NETs and delays in diagnosis, it’s common for the tumor to have spread to other parts of the body.3 In these cases, surgery may not always be possible due to the factors mentioned previously affecting the available treatment options. In metastatic cases, surgery is beneficial in helping manage the symptoms, size, and spread of the GEP-NET alongside other treatments, even if it doesn’t cure the disease.1,2 Your doctor and clinical team will discuss and recommend whether surgery is the right treatment option for you.

Medical therapy

Your doctor may also prescribe medical therapy to help slow the growth of the tumor and control any symptoms. There are many different types of medical therapy for the treatment of GEP-NETs, and most people will receive more than one of these therapies throughout their GEP-NET journey.1 Your doctor and clinical team will discuss and recommend the most clinically appropriate treatments that are right for you, based on the factors mentioned above.1

The table below summarizes the information available surrounding the most common treatment options. The treatments are listed in no particular order for how frequently they would be prescribed.

Type of medical therapy

Somatostatin analogues (SSAs)

How does it work?

Reduces the amount of hormones produced by the tumor, helping to control symptoms and slow tumor growth.4,5

When is it used?

It is common for people with GEP-NETs to be given SSA therapy as their first treatment.1

How is it administered?

Injection under the skin (subcutaneous) or into the muscle (intramuscular).4,5

A healthcare professional may administer your injections for you, or you may be able to self-administer at home.6

Radioligand therapy

How does it work?

Help control symptoms and slow tumor growth. Tumor cells are damaged by a targeted dose of radiation from inside the tumor cells.1,7

Although radioligand therapy is designed to specifically target tumor cells, the radiation may travel to nearby healthy cells too.8

When is it used?

You may be given radioligand therapy after SSAs or other therapies stop working.1

To receive radioligand therapy, the tumor(s) must have somatostatin receptors.1

How is it administered?

Infusion into a vein (intravenous).1

Everolimus

How does it work?

Reduces blood supply to tumors, which helps to slow the growth and spread of the cancer.9

When is it used?

You may be given everolimus if your GEP-NET is not causing symptoms, and your SSAs or other therapies have stopped working.1

How is it administered?

Tablet to swallow.9

Sunitinib

How does it work?

Blocks the action of molecules called receptor tyrosine kinases (TKIs),1 which contribute to the growth and spread of tumors.10 By blocking these molecules, they block the formation of new blood vessels which help the tumor to grow (antiangiogenesis).11,12

When is it used?

You may receive sunitinib if you have a neuroendocrine tumor (NET) in your pancreas.1

How is it administered?

Capsule to swallow.11

Chemotherapy

How does it work?

Chemotherapy drugs work on fast-growing parts of your body, including tumors, but also parts like hair and bone marrow.13,14

These drugs contain chemicals that damage cells as they grow and divide.13-15 This helps to slow the growth and spread of the cancer cells but can also affect rapidly-dividing healthy cells.13,14

The damage to healthy cells is usually repaired naturally after the course of chemotherapy.13

When is it used?

You may be given chemotherapy if your GEP-NET is fast-growing or has spread to other parts of the body, or if you have a NET in your pancreas.1

How is it administered?

It’s common for people to be given a combination of chemotherapy drugs for GEP-NETs.14

Depending on the type of chemotherapy you are prescribed, you may receive an infusion into a vein, or a capsule or tablet to swallow.15

Intra-arterial therapies

How does it work?

Targeted injection of particles known as “microspheres” or mixtures of chemotherapy and blood clotting agents into the body. These work to block (embolize) the blood vessels which feed the tumor and help it to grow.16,17 Some particles can contain and deliver radiation directly to the tumor.17

When is it used?

This treatment is commonly used when you aren’t eligible for surgery and the tumor particularly affects the liver or your symptoms are uncontrolled.16

How is it administered?

Injected via a tube (catheter).16

Interferon alpha (IFN-α)

How does it work?

Triggers the immune system to attack the cancer.18

When is it used?

You may receive IFN-α if the tumor lacks specific receptors called somatostatin receptors (SSTRs).1

How is it administered?

Injection under the skin (subcutaneous).18

A healthcare professional may administer your injections for you, or you may be able to self-administer at home.18

For more information on your specific GEP-NET treatment, treatment availability, or possible side effects, talk with your doctor.

Discussing your treatment with your doctor and clinical team

When it comes to your treatment plan there can be a lot of information to process, so it’s important to talk to your doctor and the clinical team if you have any questions or concerns. If possible and you feel comfortable, we would suggest you don’t go to your consultations and medical appointments alone. We’ve included some points that you may find useful when discussing your treatment with your doctor and clinical team:

Ask about your treatment options and what you can expect while receiving them. You should discuss the goals of your treatment plan, including your own personal aims and expectations. This way, you and your doctor, and clinical team can work together to choose treatments that align with your desired outcomes2
If you have been given a treatment to help manage your symptoms, ask for specific instructions linked to the treatment, this may include when to take it, how to take it, or what food or medicines you can or cannot take it with.19 Some treatments can take longer than others to start making a difference, and it’s important that you keep using the treatment as instructed by your doctor and clinical team.4 You can ask your doctor or clinical team about how much care will be needed, so you can feel more comfortable managing your symptoms at home20
If you experience any expected or unexpected side effects throughout the course of your treatment, track them and inform your doctor and clinical team regularly.20 They may be able to relieve or manage these side effects, which could help you feel more comfortable.20
It may also be helpful to discuss when your doctor and clinical team is planning to review your treatment. This may just be a conversation between you and your doctor, or they may want to run some tests or scans.1 These reviews help them to determine how well your treatment is working, and whether they need to try a different option21
In addition to approved therapies, you may want to consult your doctor and clinical team about clinical trials, a research study on a new possible therapy which involves people. If you choose to join a clinical trial, a doctor that is part of the study will check if you meet the eligibility criteria, for example if you meet the age requirement.22 You should always ask about the risks of the trial as well as the possible benefits23
References: 1. Pavel M, Oberg K, Falconi M et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020; 31(7): 844-860. 2. Cancer.Net. Neuroendocrine tumors: Types of treatment. Available at: https://www.cancer.net/cancer-types/neuroendocrine-tumors/types-treatment. Accessed: October 2021. 3. Alexandraki KI and Kaltsas G. Gastroenteropancreatic neuroendocrine tumors: new insights in the diagnosis and therapy. Endocrine. 2012; 41: 40‒52. 4. Cancer Research UK. Octreotide (Sandostatin). Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/octreotide-sandostatin. Accessed: October 2021. 5. Cancer Research UK. Lanreotide (Somatuline). Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/lanreotide-somatuline. Accessed: October 2021. 6. GStröm T, Kozlovacki G, Myrenfors P et al. Patient And Nurse Experience Of Using Somatostatin Analogues To Treat Gastroenteropancreatic Neuroendocrine Tumors: Results Of The Somatostatin Treatment Experience Trial (STREET). Patient Prefer Adherence. 2019; 13: 1799–1807. 7. Cancer Research UK. Peptide receptor radionuclide therapy (PRRT). Available at: https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/treatment/radiotherapy/peptide-receptor-radionuclide-therapy-prrt. Accessed: October 2021. 8. Zaknun J, Bodei L, Mueller-Brand J et al. The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2013; 40: 800–816. 9. Cancer Research UK. Everolimus. Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/everolimus. Accessed: October 2021. 10. Pottier C, Fresnais M, Gilon M et al. Tyrosine Kinase Inhibitors in Cancer: Breakthrough and Challenges of Targeted Therapy. Cancers (Basel). 2020; 12(3): 731. 11. Cancer Research UK. Sunitinib (Sutent). Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/sunitinib. Accessed: October 2021. 12. Bao X, Wang M-W, Zhang Y-P et al. Early Monitoring Antiangiogenesis Treatment Response of Sunitinib in U87MG Tumor Xenograft by 18F-FLT MicroPET/CT Imaging. Biomed Res Int. 2014; 2014: 218578. 13. Cancer Research UK. How chemotherapy works. Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/how-chemotherapy-works. Accessed: October 2021. 14. American Cancer Society. How Chemotherapy Drugs Work. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/how-chemotherapy-drugs-work.html. Accessed: October 2021. 15. Cancer Research UK. Having chemotherapy treatment for neuroendocrine tumours (NETs). Available at: https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/treatment/chemotherapy/having. Accessed: October 2021. 16. de Baere T, Deschamps F, Tselikas L et al. Interventional radiology: role in the treatment of liver metastases from GEP-NETs. Eur J Endocrinol. 2015; 172: R151-R166. 17. Uri I and Grozinsky-Glasberg S. Current treatment strategies for patients with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Clinical Diabetes and Endocrinology 2018; 4: 16. 18. Cancer Research UK. Interferon alfa (IntronA, Roferon-A). Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/interferon. Accessed: October 2021. 19. Cancer Research UK. Taking Medicines. Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/how-you-have/taking-medicines. Accessed: October 2021. 20. Cancer.Net. Neuroendocrine Tumors: Coping with Treatment. Available at: https://www.cancer.net/cancer-types/neuroendocrine-tumors/coping-with-treatment. Accessed: October 2021. 21. Merino-Casabiel X, Aller J, Arbizu J et al. Consensus document on the progression and treatment response criteria in gastroenteropancreatic neuroendocrine tumors. Clin Transl Oncol. 2018; 20(12): 1522–1528. 22. Cancer.Net. About Clinical Trials. Available at: https://www.cancer.net/research-and-advocacy/clinical-trials/about-clinical-trials. Accessed: October 2021. 22. National Cancer Institute. Deciding to Take Part in a Clinical Trial. Available at: https://www.cancer.gov/about-cancer/treatment/clinical-trials/taking-part. Accessed: October 2021.