JLE

Hépato-Gastro & Oncologie Digestive

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Medical treatment and new treatment options for duodenal and pancreatic endocrine tumors Volume 16, special issue 3, octobre 2009

Author
Département de cancérologie urologique et digestive, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France

In terms of incidence, malignant pancreatic endocrine tumors account for 1% of pancreatic cancers, but in terms of prevalence, they account for approximately 10%. Almost 50% are non-functioning tumors. Surgical resection is the treatment of choice, and the only curative treatment. For poorly differentiated metastatic pancreatic endocrine tumors, reference chemotherapy is a combination of Cisplatin and VP16; the prognosis is poor. Symptomatic treatment must be considered initially. Well-differentiated metastatic pancreatic endocrine tumors can be treated by intravenous chemotherapy, and the reference protocol is a combination of doxorubicin and streptozocin; doxorubicin could be replaced by 5-fluorouracil. Dacarbazine and other drugs like capecitabine and temozolomide, seem interesting. Somatostatin analogs are on evaluation for their antitumoral effect. For tumor localizations in (or predominantly in) the liver, hepatic locoregional therapies should be considered, and especially intrahepatic arterial chemo-embolisation or embolisation. Radiofrequency can be considered if liver involvement is limited. Targeted therapies are rapidly expanding, and there are positive results for some of them, or probable positive effects: mTOR and tyrosine-kinase inhibitors (RAD001 and sunitinib), and anti-angiogenics (bevacizumab). Participation to available trials is crucial.