Neues zur Therapie von neuroendokrinen Tumoren des gastroenteropankreatischen Systems

Was ist neu?

Pathologische Klassifikation und Genetik Neu in der Klassifikation der neuroendokrinen Tumoren des GEP-Systems ist seit 2017 die seltene Entität des NET G3 in Abgrenzung vom NEC. Darüber hinaus wurde der Begriff des „mixed-neuroendocrine-nonneuroendocrine neoplasms“ (MINEN) eingeführt.

Therapie Über die leitlinienbasierte Therapie von NEN des GEP-Systems hinaus besteht ein „medical need“ für neue systemische Therapieansätze. Genetik, Biomarker, neue Multi-Tyrosinkinase-Inhibitoren und Chemotherapie-Protokolle sowie kombinierte multimodale Therapieansätze wie die Peptid-Receptor-ChemoRadio-Therapie (PRCRT) sind vielversprechende neue Optionen.

Neue zukünftige Therapiekonzepte und Perspektiven Die Immuntherapie bei NET des GEP-Systems zeigt bisher in der Monotherapie eine nur geringe Effektivität und sollte deshalb vorzugsweise in Kombinationstherapien in klinischen Studien weiter evaluiert werden.

Abstract

Current guidelines have been published for the diagnosis and therapy of neuroendocrine neoplasms of the gastroenteropancreatic (GEP) system [1]. Systemic therapy of inoperable advanced neuroendocrine tumors includes biotherapy with somatostatin analogas, peptid receptor radionuclide therapy (PRRT) with 177Lutetium-DOTA-TATE, chemotherapy with steptozotocin/5-fluorouracil or capecitabine/temozolomide and molecular targeted therapy with everolimus or sunitinib [1] [2]. For symptom control in patients with carcinoid syndrome biotherapy with somatostatin analogs, PRRT, loco-regional and local-ablative interventional procedures of liver metastases as well as the peripheral serotonin synthesis inhibitor telotristat Ethyl [1] [2] [3] [4] are highly effective. Novel aspects and developments in the diagnosis and treatment of neuroendocrine tumors will be discussed in this review.

Schlüsselwörter

neuroendokrine Tumoren - Biotherapie - Peptid-Rezeptor-Radionuklid-Therapie (PRRT) - Chemotherapie - molekular zielgerichtete Therapie

Key words

neuroendocrine tumors - biotherapy - peptid receptor radionuclide therapy (PRRT) - chemotherapy - molecular targeted therapy

• Literatur

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