ceives octreotide to prevent carcinoid crisis. After recovery from the procedure, the patient experiences
improvement in his symptoms of pain and diarrhea.
He continues to receive monthly octreotide therapy
to help control his symptoms related to carcinoid
syndrome. If his disease continues to progress,
treatment on a clinical trial utilizing an inhibitor of the
VEGF pathway has been discussed.
In conclusion, systemic treatment options for
patients with advanced NET have recently become
more defined. Somatostatin analogs can improve
symptoms of hormonal excess, and recent data
also suggests that they are associated with antiproliferative effects. Novel somatostatin analogs
have been developed and are being investigated.
Furthermore, placebo-controlled randomized studies have demonstrated improved PFS durations in
patients with pancreatic NETs treated with the targeted agents sunitinib or everolimus. Future studies will likely further define the role of VEGF and
mTOR inhibitors in advanced carcinoid tumors.
While the targeted agents are associated with
favorable toxicity profiles in comparison to many
cytotoxic regimens, significant tumor regression is
uncommon. Thus, streptozocin or temozolomide-based regimens, which are associated with relatively high tumor response rates in patients with
pancreatic NET, can be considered after failure of
targeted agents or in symptomatic pancreatic NET
patients for whom significant tumor response is
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