Treatment of Advanced Unresectable Small Intestine NET (Grade 1–2), Somatostatin Receptor Positive, Without Carcinoid Syndrome
This protocol covers management of advanced, unresectable small intestine neuroendocrine tumour classified as grade 1 or grade 2, with confirmed somatostatin receptor positivity, in the absence of carcinoid syndrome.
Clinical Scenario
The tumour is advanced and cannot be surgically resected. Somatostatin receptor expression has been confirmed. The patient does not have carcinoid syndrome. Grade 1 or grade 2 tumour classification defines the biology guiding this pathway.
Treatment Approach — Partial Overview
The protocol includes an oral targeted agent — everolimus — as part of the structured treatment approach for this specific setting.
Full sequencing, eligibility criteria, and regimen details are in the complete protocol.References
DOI: 10.1111/jne.13423
- In the presence of advanced unresectable Si-NET G1 or G2 long-acting SSA (either lanreotide or octreotide) is the preferred first-line treatment (RECOMMENDATION A-1b).
- The recommended second-line treatment in the presence of SST-positive Si-NET is PRRT (RECOMMENDATION A-1b), followed by everolimus (RECOMMENDATION A-1b).
- Everolimus given orally at 10 mg/day is EMA approved for G1/G2 intestinal, pancreatic and lung NET.
- Everolimus is currently recommended following PRRT in patients with SST expressing NET given the good tolerability of PRRT, favourable impact on quality of life and durable benefit although data from a prospective randomised trial is still lacking.