TY - JOUR
T1 - Systemic Therapy for Tumor Control in Metastatic Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors
T2 - ASCO Guideline
AU - Del Rivero, Jaydira
AU - Perez, Kimberly
AU - Kennedy, Erin B.
AU - Mittra, Erik S.
AU - Vijayvergia, Namrata
AU - Arshad, Junaid
AU - Basu, Sandip
AU - Chauhan, Aman
AU - Dasari, Arvind N.
AU - Bellizzi, Andrew M.
AU - Gangi, Alexandra
AU - Grady, Erin
AU - Howe, James R.
AU - Ivanidze, Jana
AU - Lewis, Mark
AU - Mailman, Josh
AU - Raj, Nitya
AU - Soares, Heloisa P.
AU - Soulen, Michael C.
AU - White, Sarah B.
AU - Chan, Jennifer A.
AU - Kunz, Pamela L.
AU - Singh, Simron
AU - Halfdanarson, Thorvardur R.
AU - Strosberg, Jonathan R.
AU - Bergsland, Emily K.
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2023/11/10
Y1 - 2023/11/10
N2 - PURPOSETo develop recommendations for systemic therapy for well-differentiated grade 1 (G1) to grade 3 (G3) metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs).METHODSASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice.RESULTSEight randomized controlled trials met the inclusion criteria for the systematic review.RECOMMENDATIONSSomatostatin 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)â € "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.
AB - PURPOSETo develop recommendations for systemic therapy for well-differentiated grade 1 (G1) to grade 3 (G3) metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs).METHODSASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice.RESULTSEight randomized controlled trials met the inclusion criteria for the systematic review.RECOMMENDATIONSSomatostatin 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)â € "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.
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U2 - 10.1200/JCO.23.01529
DO - 10.1200/JCO.23.01529
M3 - Article
C2 - 37774329
AN - SCOPUS:85176509017
SN - 0732-183X
VL - 41
SP - 5049
EP - 5067
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 32
ER -