Neuroendocrine Treatment Options

About RMCC

Scientific advances in the understanding of neuroendocrine tumors (NET) can provide hope for your treatment. Due to the complexity and rarity of NETs, identifying the best path for treatment can be difficult. The truth is, treatment options for NETs can vary based on the characteristics of your cancer. These factors include tumor type, location, and severity. Your entire medical history will be taken into account before establishing a long-term treatment plan. 

Rocky Mountain Cancer Centers (RMCC) provides our patients with a broad understanding of NETs. This helps you better understand how your diagnosis and treatment plan applies to your specific situation. This approach also gives you the knowledge to understand your options and work cooperatively toward their recommended treatment. There is no one-size-fits-all approach. However, our Neuroendocrine specialists will evaluate your condition before customizing a treatment plan. 

Neuroendocrine Tumor Characteristics Impact Treatment Plans

It’s important to understand that the details of your NETs diagnosis plays a role in the type of treatment plan that may work best.  

Location  

Neuroendocrine tumors can be located in virtually any area of the body. The location of the cancer may affect the type of symptoms you experience or the available treatment options.  

Grades

The grade of the NET plays a role in which treatments are recommended. Your oncologist may discuss whether your tumor is well-differentiated or poorly-differentiated. Well-differentiated tumors typically grow slower. Poorly-differentiated tumors are less predictable and may require additional treatments. This may open several treatment plan options to be tried one at a time to see which gives the best results. Your oncologist will always start with the one that they believe will be most effective. However, if it’s not working as planned, other treatments can be tried. 

Symptoms 

The severity of symptoms and the patient’s overall health are important parts to consider when choosing the best treatment plan. Patients with NETs rarely present textbook symptoms. Instead, many people often have stomach-related symptoms that may be initially diagnosed as other illnesses. It helps if you discuss all symptoms, even if they don’t seem like they’re related to one another, with your oncologist to receive a proper diagnosis and treatment plan. 

Overview of Treatment Options for Neuroendocrine Tumors

It’s helpful to understand some of the complex NET treatments as a whole. NETs are often diagnosed at a later stage with cancer cells that have spread to other areas of the body, called metastatic disease. However, metastatic tumors generally advance more slowly. The slower advancement can mean longer survival rates. In fact, even widespread disease may not necessarily mean that treatment options are limited. 

NET treatment and therapy can be divided into two categories: systemic and local treatments. As mentioned, the category of treatment is based on the patient’s symptoms and overall medical history.

Watchful Waiting

If found early, your oncologist may suggest watchful waiting, also known as active surveillance. It may also be used for patients who are older or who have underlying health conditions. During this period, your oncologist will request increased monitoring, imaging, and testing to track the progression of cancer. If they feel that your NETs are growing slowly, they may recommend waiting to receive the treatments that could really impact your quality of life. While active surveillance does not take immediate steps to reduce or eliminate cancer, your medical team can closely identify when medical treatment options should begin.

During watchful waiting, you should expect to see your oncologist every three to six months. After about a year, your doctor may suggest a biopsy to assess the condition of the NET. The results of your biopsy can be used to evaluate your current treatment plan. 

Systemic Treatment Options for Neuroendocrine Tumors

Systemic treatments are classified as treatments that use medication to go throughout the whole body. It works to treat cancer cells wherever they are. The medication types range from targeted therapies, hormonal therapy, and chemotherapy. 

Hormonal Therapy–Somatostatin Analogs (SSAS) 

Biotherapy with SSAS is a standard option for treating symptoms of NETs. It has also been proven to slow down tumor growth. Biotherapy is a type of treatment that uses materials from living organisms to treat the disease. There are two types of SSAS available:

  • Octreotide:  This medication is available in short-acting and long-acting doses. Short-acting medications may provide immediate relief lasting 4-6 hours that must be given 2-4 times a day. This type of treatment may be more appropriate for flare-up symptoms.
  • Lanreotide:  This medication is available in long-acting doses. Long-acting medications are best for managing chronic symptoms that are more regular and persistent. 

Chemotherapy

Chemotherapy is a NET cancer treatment given to patients with more aggressive (fast-growing) tumor growths. Your oncologist may refer to them as neuroendocrine carcinomas. This type of cancer often returns but may respond better to chemotherapy. Chemotherapy is especially a preferred treatment method for patients with NET that began in the pancreas. Chemotherapy is given either orally or through an IV. Doctors may suggest chemotherapy under two conditions:

  • The tumor is likely to return.
  • The tumor has spread to other organs.
  • The tumor can’t be surgically removed.
  • There are severe symptoms associated with NET.
  • Other medications, such as somatostatin or targeted therapies have been unsuccessful. 

Targeted Therapy 

Targeted therapies focus on destroying specific genes or proteins in a tumor. Eliminating those proteins or genes makes it so that the cancer cells cannot grow or spread. This type of cancer treatment uses medications and other substances to target molecules in cancer cells. Doctors can determine the makeup of the tumor by a series of tests. Targeted therapies may be especially beneficial for cancer cells that are slower growing. 

Keep in mind that not all types of tumors have the same targets. Your oncologists will need to identify your tumor’s targets before choosing a course of action. The doctor will run a series of tests to determine the nature of the tumor, such as the tumor’s genes and proteins. 

Several medications fall into these categories. However, the most recent option available at RMCC is Lutathera®. Lutathera is known as radioisotope therapy. It is a treatment for cancers affecting the neuroendocrine cells of the pancreas and parts of the stomach. This medication has been proven to slow or stop the growth of the tumor. It works as a targeted radioactive therapy that delivers the medication directly to the tumor while sparing healthy cells. 

Biologic Therapy 

Biologic therapy or immunotherapy is one possible NET treatment that may be recommended for you. Interferon helps the body’s immune system work better and can also reduce symptoms such as diarrhea and flushing. Interferon may also shrink tumors. 

Your oncologist may use materials produced naturally by your body or in a research lab. These materials are then used to strengthen your immune system. Once it is strong enough, it can fight the cancer cells and reduce symptoms. 

Local Treatment Options for Neuroendocrine Tumors

Local treatments are designed to treat one specific area of the body. This option for NETs may include surgery, radiation therapy, or liver-directed therapy. 

Surgery

If surgery is possible, oncologists often prefer it as a first treatment option. The location and size of the tumor will likely determine if surgical removal is possible. However, even if the tumor can’t be removed completely, partial removal may be another solution. Doing so can help relieve symptoms, prevent problems, and even slow the tumor’s progression. Surgery provides relief from symptoms and delays the need for systemic treatments. 

Radiation Therapy

External beam radiation therapy is used when treating pain or pressure associated with your cancer. This treatment works especially well for patients with pancreatic NETs that have spread to the bone. Radiation therapy can also be useful for treating tumors that are located deeper inside the body. Radiation therapy is usually given to patients daily, on a set schedule over a period of several weeks. Chemotherapy targets cancer by placing medication inside of the body. However, radiation therapy uses a machine that targets cancer from the outside. 

Side effects of radiation therapy are often mild. These symptoms may include fatigue, nausea, and redness to the treated area. Most patients say that the side effects decrease after their treatment is completed. 

Liver-Directed Therapy

Unfortunately, 90% of NET patients will have cancer spread to the liver. Embolization is a procedure that uses tiny particles to block blood vessels. Without a blood source, the tumor is unable to grow. 

Advanced techniques of this treatment include: 

  • Bland embolization: Uses oil, gelatin, or other small particles to cut off the artery’s supply.
  • Chemoembolization: Combines chemotherapeutic medications with the embolization. This causes the medication to get trapped in the tumor.
  • Radioembolization: Uses a concentrated combination of radiation targeting the tumor. 

Clinical Trials

Clinical trials can be an excellent option for NET patients. Clinical trials pair candidates with new and emerging treatment options. You may be interested in clinical trials if other treatments aren’t providing relief. Speak with your oncologist if you would like to learn more about clinical trials that may be available to NETs patients at our clinics throughout Colorado.  

Find a Neuroendocrine Specialist

NET diagnosis does not mean that options are limited. As you can see, there are many NET treatment options available. Patients with a more aggressive diagnosis may still have hope for finding an effective solution.

RMCC values patient education, and we strive to keep you informed throughout every stage of the process. Do you have questions about your treatment options? We encourage you to reach out to Dr. Liu, our Neuroendocrine specialist, today. Dr. Liu can meet with you for a second opinion if you’ve already received a treatment plan. We look forward to answering your questions and providing the help you need to make informed decisions about your health.