ESMO E-Learning: Overview of Management of Well-Differentiated Pancreatic Neuroendocrine Tumours (PanNETs)

In this E-Learning module, the author provides the current state-of-the-art and future outlook in terms of management of patients with well-differentiated pancreatic neuroendocrine tumours (panNETs). The content covers essential facts in epidemiology, clinical presentation, grading and staging and moreover gives an overview of data from the clinical trials and challenges to be solved in the future research agenda.

PanNETs are rare types of neoplasms, whose incidence and prevalence are increasing. Proliferation index and morphology are the cornerstone of tumour classification, which impacts both treatment and prognosis. Discussion of patients in expert multidisciplinary teams is recommended for adequate treatment planning at the time of the presentation.

In the part of the module dedicated to localised disease, the author elaborates on the principles of surgical management, adjuvant treatment, risk stratification and post-surgical follow-up. In the advanced stage disease, the author analyses how to select the most adequate treatment, liver-directed therapies, somatostatin analogues, targeted therapies, chemotherapy and peptide receptor radionuclide therapy (PRRT). In the last part of the module on the future of management, the author elaborates on new targeted therapies, challenges for treatment sequencing and immunotherapy.   

The author underlines that surgery is the only curative treatment for localised disease. Surgery for metastatic disease, if resectable, does have a role. Liver directed therapies are of use for patients with unresectable liver disease if liver predominant or functional symptoms are present. Systemic treatment includes somatostatin analogues, targeted therapies, chemotherapy and PRRT. Most adequate treatment sequencing is unknown and is a current challenge. This E-Learning module provides a comprehensive overview of the management and of the still open questions in the panNETs field.