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The neuroendocrine tumour (NET) unit at the Royal Free Hospital provides optimal management for patients with NETs, taking into account how the tumour affects each individual.
This page provides information on the treatment options available.
Where possible, surgery is performed with the intention of removing the tumour in the hope of curing the disease.
Sometimes ‘debulking’ surgery is performed in order to remove as much of the tumour as possible, so that other treatments have less tumour to treat.
Somatostatin analogues (SSTAs), such as daily octreotide injections or long-acting preparations such as Sandostatin LAR or Lanreotide Autogel which are given monthly, are very useful for controlling the symptoms of hormone release by carcinoid or pancreatic NETs.
They have an anti-tumour effect and, in many patients, SSTAs are the first option for tumour control and treatment.
Molecular targeted agents such as everolimus and sunitinib are tablets which have an anti-tumour effect by blocking enzymes (chemicals) associated with NET growth. They are usually used in the treatment of pancreatic NETs.
Everolimus is also licensed for bronchial NETs and is occasionally used in intestinal NETs.
Chemotherapy is usually reserved for faster growing NETs, especially if there is a lot of disease. Pancreatic NETs and bronchial NETs are more sensitive to chemotherapy than intestinal tumours. Chemotherapy is also the treatment of choice for ‘poorly differentiated’ tumours (on biopsy).
The chemotherapy agents often considered include a combination of the oral tablet form of capecitabine and temozolomide.
For more aggressive tumours, intravenous chemotherapy regimens, such as streptozocin, 5 fluorouracil and carboplatin, may be considered alongside other regimens such as FOLFIRI or FOLFOX.
Interferon stimulates the immune system to fight cancer and may be effective, especially in combination with somatostatin analogues.
PRRT/RLT may be of benefit to patients who have positive scans, for example those patients who have positive gallium-68 DOTA octreotate PET scans.
The diagnostic gallium-68 radioactive molecule is changed for the beta-emitting molecule lutetium-177, thus making lutetium-177 DOTA octreotate, with the aim of targeting and killing tumour cells.
In the NHS, PRRT with lutetium-177 is approved for treatment of gastroenteropancreatic (GEP) NETs.
Non-GEP NETs (ie bronchial NETs, paraganglioma, phaeochromocytoma, medullary thyroid cancer and those requiring retreatment, which are not funded by the NHS) can only be treated within a clinical trial.
Liver embolization involves cutting off the blood supply to tumours in the liver, with or without the addition of chemotherapy (chemoembolization). It is useful for patients who have predominantly liver disease.
Thermal ablation such as radio-frequency ablation (probes that ‘burn’ away the tumours) may be useful in patients who have a small number of liver tumours.
Liver transplantation is rarely used. It is only considered in patients who have disease confined to the liver and have had investigations to fully exclude disease outside of the liver.
Other criteria also need to be met, as there is concern around recurrence of the disease after liver transplant.
The treatment of patients with NETs is a rapidly advancing field and new treatments are being developed all the time. Many patients will therefore be offered the option of being involved in clinical trials.
