Is There A Place for Systemic Chemotherapy and Targeted Agents in Metastatic Small Intestine Neuroendocrine Tumors?

Neuroendocrine tumors (NETs) demonstrate a widely variable clinical behavior but in general they have an indolent clinical course. Small intestine NETs (SI-NETs) of Grades 1 and 2 have rather limited response rates to systemic chemotherapy of about 10%-30% [1-2]. Reports in the literature describe the low activity of chemotherapeutic drugs such as 5-FU/capecitabine given in combination to either oxaliplatin or dacarbazine/epirubicin or temozolomide [3-6]. Nevertheless, somatostatin analogs (SSAs) can control hormonal symptoms in the majority of the patients. Furthermore, SSAs show antiproliferative action. However, it is known that occasional well-differentiated SI-NETs may show a discrepancy between the proliferative index of the primary and the metastasis, necessitating the prompt initiation of systemic treatment [7].