Treatment of Recurrent and Progressive Pancreatic Neuroendocrine Tumors

There is no established therapy for pancreatic neuroendocrine tumors that recur or progress after previous therapy.[1] Deciding on further treatment depends on many factors, including:

Attempts at re-resection of local tumors that have recurred or re-resection of metastatic lesions may offer palliation, when technically feasible. Intra-arterial chemotherapy is a consideration for patients with liver metastases. Patients with hepatic-dominant disease and substantial symptoms caused by tumor bulk or hormone-release syndromes may benefit from continuous-infusion intra-arterial chemotherapy or procedures that reduce hepatic arterial blood flow to metastases (hepatic arterial occlusion with embolization or with chemoembolization).[2-7] Such treatment may also be combined with systemic chemotherapy. A variety of systemic agents have shown biological or palliative activity,[1,8] including: