Chemotherapy Treatment of Advanced Neuroendocrine Cancer
Patients with advanced neuroendocrine cancer often have a great deal of cancer spread at the time of diagnosis and surgery will not provide a cure.
Systemic treatment is called chemotherapy. Chemotherapy can also destroy cancer cells that have metastasized to parts of the body away from the original tumor site. Combining two or more chemotherapy agents can be used for treatment of neuroendocrine cancer, as this will help to provide a better response overall.
Chemo is most often used to treat pancreatic neuroendocrine tumors (NETs) if they:
- Have not responded to other medicines (such as somatostatin or targeted treatments),
- Have spread to other organs,
- Are large or growing quickly,
- Are causing severe symptoms
- Are high grade (grade 3)
The most commonly used treatments for pancreatic NETs include:
- Doxorubicin (Adriamycin)
- Fluorouracil (5-FU)
- Dacarbazine (DTIC)
- Temozolomide (Temodar)
- Capecitabine (Xeloda)
- Oxaliplatin (Eloxatin)
Some tumors might be treated with more than one drug. Possible combinations include:
- Doxorubicin plus streptozocin
- 5-FU plus doxorubicin plus streptozocin
- Temozolomide plus capecitabine
- 5-FU plus streptozocin
Chemotherapy can also be used in combination with somatostatin and immuno-oncology or immunotherapy.
For people with advanced neuroendocrine tumors (NETs), several medicines can help control symptoms and tumor growth. These drugs are used mainly when the tumor can’t be removed with surgery.
- Octreotide (Sandostatin)
- Lanreotide (Somatuline Depot
Other treatments used for specific NETs
Somatostatin analogs can be used to treat most NETs. However, other treatments may be added to treat specific symptoms or problems that are caused by the excess hormone being produced by the cancer.
Gastrinomas make too make gastrin, which increases stomach acid levels, and can lead to stomach ulcers. Proton pump inhibitors, for example omeprazole (Prilosec), esomeprazole (Nexium), or lansoprazole (Prevacid), block stomach acid production and may be given to decrease the chance of ulcers forming.
Insulinomas make too much insulin which causes very low blood glucose (sugar) levels. If the somatostatin receptor scintigraphy (SRS) or gallium-68 Dotatate scans are negative, showing the cancer does not have the somatostatin protein, then other treatments besides somatostatin analogs are considered to even out glucose levels. Diazoxide, a drug that keeps insulin from being released into the bloodstream, or diet changes (higher carbohydrate intake or more frequent meals) may be started to raise glucose levels.
Glucagonomas make too much glucagon, a hormone that increases blood glucose (sugar) levels. It works opposite of insulin. These cancers may be treated with medicines for diabetes if somatostatin analogs alone are not enough to control the high glucose levels.
VIPomas make too much vasoactive intestinal peptide (VIP), a hormone that regulates water and mineral (such as potassium and magnesium) levels in the gut. Treatment may involve giving intravenous (IV) fluids to treat the dehydration from diarrhea as well as certain minerals that are low.