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Der Nuklearmediziner 2021; 44(04): 326-333
DOI: 10.1055/a-1556-8264
Quo vadis NET?

Medikamentöse Systemtherapie bei Neuroendokrinen Neoplasien des GastroEnteropankreatischen Systems

Systemic treatment options for neuroendocrine neoplasias of the gastroenteropancreatic system
Christoph Josef Auernhammer
1   Medizinische Klinik 4, LMU Klinikum, Ludwig-Maximilians-Universität, München
4   ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Klinikum, Ludwig-Maximilians-Universität, München
,
Stefan Böck
2   Medizinische Klinik 3, LMU Klinikum, Ludwig-Maximilians-Universität, München
4   ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Klinikum, Ludwig-Maximilians-Universität, München
,
Christoph Benedikt Westphalen
2   Medizinische Klinik 3, LMU Klinikum, Ludwig-Maximilians-Universität, München
4   ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Klinikum, Ludwig-Maximilians-Universität, München
,
Leonie Beyer
3   Klinik und Poliklinik für Nuklearmedizin, LMU Klinikum, Ludwig-Maximilians-Universität, München
4   ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Klinikum, Ludwig-Maximilians-Universität, München
,
Christine Spitzweg
1   Medizinische Klinik 4, LMU Klinikum, Ludwig-Maximilians-Universität, München
4   ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Klinikum, Ludwig-Maximilians-Universität, München
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Zusammenfassung

Neuroendokrine Neoplasien (NEN) des GastroEnteroPankreatischens Systems (GEP-Systems) im inoperablen fortgeschrittenen Stadium erfordern eine differenzierte Systemtherapie abhängig von Klassifikation und Grading, Primärtumorlokalisation, Somatostatinrezeptorexpression, Tumordynamik, Tumorlast und Funktionalität. Somatostatinanaloga, Peptid Rezeptor Radionuklid Therapie (PRRT), Streptozotocin- oder Temozolomid-basierte Chemotherapieprotokolle und molekular zielgerichtete Therapien mit Everolimus oder Sunitinib sind jeweils etablierte Therapieoptionen bei verschiedenen neuroendokrinen Tumoren (NET). Neue vielversprechende Therapieansätze sind Multityrosinkinaseinhibitoren (TKIs) wie Surufatinib, Cabozantinib, Lenvatinib oder Pazopanib. Cisplatin/Etoposid ist die Standard 1st-line Chemotherapie bei neuroendokrinen Karzinomen (NEC). Bisher zeigten die meisten klinischen Studien zur Immuntherapie bei NET G1/G2 enttäuschende Studienergebnisse, aber die mögliche Effektivität der kombinierten Checkpoint-Inhibition sollte bei höherproliferativen NEN G3 weiter untersucht werden. Molekularpathologie mit Next Generation Sequencing (NGS) und personalisierte Therapie spielen auch bei den NEN eine zunehmende Rolle.

Abstract

Inoperable advanced neuroendocrine neoplasias (NEN) of the GastroEnteroPancreatic Systems (GEP-System) need differentiated systemic treatment strategies depending on classification and grading, primary tumor location, somatostatin receptor expression, tumor dynamics, tumor load, and functionality. Somatostatin analogs, peptide receptor radionuclide therapy (PRRT), streptozotocin- or temozolomide-based chemotherapy protocols and molecularly targeted therapies with everolimus or sunitinib are established therapeutic options in the various neuroendocrine tumors (NET). New promising therapeutic options are multi tyrosine kinase inhibitors (TKIs), such as surufatinib, cabozantinib, lenvatinib, or pazopanib. Cisplatin/Etoposid is standard 1st-line chemotherapy in neuroendocrine carcinomas (NEC). So far, most clinical trials with immunotherapy in NET G1/G2 have shown disappointing results, however the efficacy of combined checkpoint inhibitor therapy should be further investigated in higher proliferative NEN G3. Molecular pathology using next generation sequencing (NGS) and personalized therapy approaches play an increasing role in NENs.

Schlüsselwörter

Neuroendokriner Tumor - Neuroendokrines Karzinom - Somatostatinanaloga - PRRT - Chemotherapie - molekular zielgerichtete Therapie - Immuntherapie - Next Generation Sequencing

Keywords

Neuroendocrine tumor - neuroendocrine carcinoma - somatostatin analoga - PRRT - chemotherapy - molecularly targeted therapy - immune therapy - next generation sequencing


Publication History

Article published online:
29 November 2021

© 2021. Thieme. All rights reserved.

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