Therapeutic strategies for patients with neuroendocrine neoplasms: current perspectives
Abstract
INTRODUCTION: Neuroendocrine neoplasms (NENs) are a heterogeneous group of malignancies mainly arising in the gastroenteropancreatic (GEP) and bronchopulmonary systems, with steadily increasing incidence. The therapeutic landscape has widened and the therapeutic strategy should be based on new sequences and combinations, still debated. AREAS COVERED: Herein, we provide an overview of current approved pharmacological treatments in patients with NENs, with the aim to summarize evidence of efficacy of the main different options in GEP and pulmonary NENs, principally focusing on somatostatin analogs (SSAs), targeted therapy with everolimus and sunitinib, peptide receptor radionuclide therapy (PRRT) and chemotherapy. We discuss biological rationale and toxicities, including current indications according to differentiation and placement in the therapeutic algorithm, clinical trials, and combinations. Furthermore, we recommend areas for further research. EXPERT OPINION: Therapeutic management of patients with NENs represents a challenge for clinicians and the identification of effective sequences and combinations is of utmost importance. Major efforts should be directed to early identify and overcome resistance and to limit toxicity. The progress in the therapeutic management of NENs grows faster and the choice of the best approach should be based on randomized clinical trials, as well as on long-term, real-world data.
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177Lu-DOTATATE is efficacious in halting tumor progression and inducing regression in NETs.
“Radiopharmaceutical case studies demonstrate the efficacy of 177Lu-DOTATATE in halting tumor progression and inducing regression, providing evidence for its inclusion in therapeutic protocols [93].”
From Radiopharmaceuticals: navigating the frontier of precision medicine and therapeutic innovation (2024) · cites this paper as [93]
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Faggiano, A., Calzo, F. L., Pizza, G., Modica, R., & Colao, A. A. L. (2017) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2017.1354984 · Cited by 42 · see citing works
Self-citationEscalated-dose somatostatin analogues for antiproliferative effect in GEPNETS: a systematic review
Chan, D. L. H., Ferone, D., Albertelli, M., Pavlakis, N., Segelov, E., & Singh, S. (2017) · Endocrine · doi:10.1007/s12020-017-1360-z · Cited by 42 · see citing works
Lamberti, G., Faggiano, A., Brighi, N., Tafuto, S., Ibrahim, T., Brizzi, M. P., Pusceddu, S., Albertelli, M., Massironi, S., Panzuto, F., et al. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgz035 · Cited by 42 · see citing works
Self-citationPauwels, E., Binnebeek, S. V., Vandecaveye, V., Baete, K., Vanbilloen, H. P., Koole, M. J. B., Mottaghy, F. M., Haustermans, K. M., Clément, P. M., Nackaerts, K., et al. (2019) · Journal of Nuclear Medicine · doi:10.2967/jnumed.119.236935 · Cited by 42 · see citing works
Brighi, N., Panzuto, F., Modica, R., Gelsomino, F., Albertelli, M., Pusceddu, S., Massironi, S., Lamberti, G., Rinzivillo, M., Faggiano, A., et al. (2019) · The Oncologist · doi:10.1634/theoncologist.2019-0403 · Cited by 36 · see citing works
Self-citationFaggiano, A., Carratù, A. C., Guadagno, E., Tafuto, S., Tatangelo, F., Riccardi, F., Mocerino, C., Palmieri, G., Damiano, V., Siciliano, R., et al. (2015) · Oncotarget · doi:10.18632/oncotarget.6686 · Cited by 35 · see citing works
Self-citationScandurra, C., Modica, R., Maldonato, N. M., Dolce, P., Dipietrangelo, G. G., Centello, R., Vito, V. D., Bottiglieri, F., de Cicco, F., Giannetta, E., et al. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa760 · Cited by 35 · see citing works
Self-citationELIOS, O. B. O., Faggiano, A., Maio, S. D., Mocerino, C., Ottaviano, M., Divitiis, C. D., Guarnotta, V., Dolce, P., Modica, R., Puliafito, I., et al. (2019) · Endocrine · doi:10.1007/s12020-019-01894-0 · Cited by 34 · see citing works
Self-citationPRRT: identikit of the perfect patient
Albertelli, M., Dotto, A., Dato, C. D., Malandrino, P., Modica, R., Versari, A., Colao, A. A. L., Ferone, D., Faggiano, A., & on behalf of, N. I. K. E. (2020) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-020-09581-6 · Cited by 34 · see citing works
Self-citationRole of Somatostatin Analogues in the Treatment of Neuroendocrine Tumors
Narayanan, S., & Kunz, P. L. (2015) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2015.0012 · Cited by 32 · see citing works
When should genetic testing be performed in patients with neuroendocrine tumours?
O’Shea, T., & Druce, M. R. (2017) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-017-9430-3 · Cited by 31 · see citing works
PRRT of neuroendocrine tumors: individualized dosimetry or fixed dose scheme?
Haug, A. R. (2020) · EJNMMI Research · doi:10.1186/s13550-020-00623-3 · Cited by 31 · see citing works
Phase I Study of Pasireotide (SOM 230) and Everolimus (RAD001) in Advanced Neuroendocrine Tumors
Chan, J., Ryan, D., Zhu, A., Abrams, T., Wolpin, B., Malinowski, P., Regan, E., Fuchs, C., & Kulke, M. (2012) · Endocrine-Related Cancer · doi:10.1530/erc-11-0382 · Cited by 30 · see citing works
Fanciulli, G., Molfetta, S. D., Dotto, A., Florio, T., Feola, T., Rubino, M., de Cicco, F., Colao, A., Faggiano, A., & NIKE Group (2020) · Journal of Clinical Medicine · doi:10.3390/jcm10010088 · Cited by 29 · see citing works
Self-citationFisher, G. A., Wolin, E. M., Liyanage, N., Lowenthal, S. P., Mirakhur, B., Pommier, R. F., Shaheen, M. F., Vinik, A. I., & on behalf of the ELECT Study Group (2017) · The Oncologist · doi:10.1634/theoncologist.2017-0284 · Cited by 27 · see citing works
Neoadjuvant Therapy for Neuroendocrine Neoplasms: Recent Progresses and Future Approaches
Lania, A. G., Ferraù, F., Rubino, M., Modica, R., Colao, A. A. L., & Faggiano, A. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.651438 · Cited by 27 · see citing works
Self-citationLaskaratos, F., Walker, M., Naik, K., Maragkoudakis, E., Oikonomopoulos, N., Grant, L. A., Meyer, T., Caplin, M. E., & Toumpanakis, C. (2016) · British Journal of Cancer · doi:10.1038/bjc.2016.349 · Cited by 26 · see citing works
Ostwal, V. S., Basu, S. K., BHARGAVA, P. G., Shah, M. J., Parghane, R. V., Srinivas, S., Chaudhari, V. A., BHANDARE, M. S., Shrikhande, S. V., & Ramaswamy, A. (2020) · Neuroendocrinology · doi:10.1159/000511987 · Cited by 24 · see citing works
Faggiano, A., Malandrino, P., Modica, R., Agrimi, D., Aversano, M., Bassi, V., Giordano, E., Guarnotta, V., Logoluso, F. A., Messina, E., et al. (2016) · The Oncologist · doi:10.1634/theoncologist.2015-0420 · Cited by 22 · see citing works
Self-citationPredictive Markers of Response to Everolimus and Sunitinib in Neuroendocrine Tumors
Martins, D., Spada, F., Lambrescu, I. M., Rubino, M., Cella, C. A., Gibelli, B., Grana, C. M., Ribero, D., Bertani, E., Ravizza, D., et al. (2017) · Targeted Oncology · doi:10.1007/s11523-017-0506-5 · Cited by 21 · see citing works
Sunitinib in patients with pre-treated pancreatic neuroendocrine tumors: A real-world study
Rinzivillo, M., Fazio, N., Pusceddu, S., Spallanzani, A., Ibrahim, T., Campana, D., Marconcini, R., Partelli, S., Badalamenti, G., Brizzi, M. P., et al. (2018) · Pancreatology · doi:10.1016/j.pan.2018.01.005 · Cited by 20 · see citing works
Tafuto, S., von Arx, C., Capozzi, M., Tatangelo, F., Mura, M., Modica, R., Barretta, M. L., Sarno, A. D., Tornesello, M. L., Colao, A., et al. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8081224 · Cited by 18 · see citing works
Self-citationMassironi, S., Campana, D., Pusceddu, S., Albertelli, M., Faggiano, A., Panzuto, F., Smiroldo, V., Andreasi, V., Rossi, R. E., Maggio, I., et al. (2020) · Digestive and Liver Disease · doi:10.1016/j.dld.2020.09.031 · Cited by 18 · see citing works
Self-citationOpen issues on G3 neuroendocrine neoplasms: back to the future
Zatelli, M. C., Guadagno, E., Messina, E., Calzo, F. L., Faggiano, A., Colao, A., & _, _. (2018) · Endocrine Related Cancer · doi:10.1530/erc-17-0507 · Cited by 17 · see citing works
Self-citationOn behalf of NIKE Group, Gallo, M., Malandrino, P., Fanciulli, G., Rota, F., Faggiano, A., & Colao, A. (2017) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-017-2407-5 · Cited by 15 · see citing works
Self-citationSyguła, A., Ledwoń, A., Hasse-Lazar, K., Jurecka‐Lubieniecka, B., Michalik, B., Paliczka-Cieślik, E., Zeman, M., Chmielik, E., Sczasny, J., Jarząb, B., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05792-y · Cited by 15 · see citing works
Ferollà, P., Berruti, A., Spada, F., Brizzi, M. P., Ibrahim, T., Colao, A. A. L., Faggiano, A., Marconcini, R., Vaccaro, V., Giuffrida, D., et al. (2020) · Annals of Oncology · doi:10.1016/j.annonc.2020.08.1374 · Cited by 11 · see citing works
Self-citationSunitinib-Induced Hypothyroidism and Survival in Pancreatic Neuroendocrine Tumors
Mathew, A., Führer, D., & Lahner, H. (2021) · Hormone and Metabolic Research · doi:10.1055/a-1658-3077 · Cited by 11 · see citing works
Ida, A., Okubo, Y., Kasajima, R., Washimi, K., Sato, S., Yoshioka, E., Osaka, K., Suzuki, T., Yamamoto, Y., Yokose, T., et al. (2021) · Pathology - Research and Practice · doi:10.1016/j.prp.2021.153731 · Cited by 10 · see citing works
Baudin, É., Berruti, A., Giuliano, M., Mansoor, W., Bobirca, C., Houtsma, E., Fagan, N., Öberg, K. E., & Ferollà, P. (2021) · Journal of Clinical Oncology · doi:10.1200/jco.2021.39.15_suppl.8574 · Cited by 8 · see citing works
Fraeyenhove, F. V., Meireson, N., Terriere, L., Willemsen, P. J., Kunnen, J., Mattelaer, C., Acker, F. V., & Schrijvers, D. L. A. L. (2014) · Case Reports in Oncology · doi:10.1159/000360732 · Cited by 7 · see citing works
Gao, H., Dong, J., Zhang, W., Xu, H., Ye, L., Li, H., Ni, Q., Wang, W., & Liu, L. (2021) · Endocrine Practice · doi:10.1016/j.eprac.2021.08.008 · Cited by 4 · see citing works
Swain, J. (2018) · http://isrctn.com/ · doi:10.1186/isrctn10996604 · Cited by 1 · see citing works
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Radiopharmaceuticals: navigating the frontier of precision medicine and therapeutic innovation
Dhoundiyal, S., Srivastava, S., Kumar, S., Singh, G., Ashique, S., Pal, R., Mishra, N., & Taghizadeh-Hesary, F. (2024) · European Journal of Medical Research · doi:10.1186/s40001-023-01627-0 · Cited by 144 · see citing works
“Radiopharmaceutical case studies demonstrate the efficacy of 177 Lu-DOTATATE in halting tumor progression and inducing regression, providing evidence for its inclusion in therapeutic protocols [93].”
BackgroundUccella, S. (2024) · Endocrine Pathology · doi:10.1007/s12022-024-09807-2 · Cited by 32 · see citing works
Modica, R., Salvia, A. L., Liccardi, A., Cannavale, G., Minotta, R., Benevento, E., Faggiano, A., & Colao, A. A. L. (2022) · Metabolites · doi:10.3390/metabo12111057 · Cited by 29 · see citing works
Self-citationRecent advances and future challenges in the diagnosis of neuroendocrine neoplasms
Modica, R., Benevento, E., Liccardi, A., Cannavale, G., Minotta, R., Iasi, G. D., & Colao, A. A. L. (2024) · Minerva Endocrinology · doi:10.23736/s2724-6507.23.04140-4 · Cited by 22 · see citing works
Self-citationPsychological distress and resilience in patients with gastroenteropancreatic neuroendocrine tumor
Lili, S., Cao, Y., Li, J., Lu, M., & Tang, L. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.947998 · Cited by 20 · see citing works
Current understanding of pathogenetic mechanisms in neuroendocrine neoplasms
Modica, R., Liccardi, A., Minotta, R., Cannavale, G., Benevento, E., & Colao, A. A. L. (2023) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2023.2279540 · Cited by 20 · see citing works
Self-citationWang, F.-G., Jiang, Y., Liu, C., & Qi, H. (2023) · Journal of Investigative Surgery · doi:10.1080/08941939.2023.2278191 · Cited by 16 · see citing works
Maratta, M. G., Al‐Toubah, T., Montilla-Soler, J., Pellè, E., Haider, M., El-Haddad, G. E., & Strosberg, J. (2025) · Cancers · doi:10.3390/cancers17121937 · Cited by 15 · see citing works
Dyslipidemia, lipid-lowering agents and neuroendocrine neoplasms: new horizons
Modica, R., Salvia, A. L., Liccardi, A., Cozzolino, A., Sarno, A. D., Russo, F., Colao, A., Faggiano, A., & on behalf of NIKE group (2024) · Endocrine · doi:10.1007/s12020-024-03767-7 · Cited by 14 · see citing works
Self-citationNaraev, B. G., Mailman, J. A., Halfdanarson, T. R., Soares, H. P., Mittra, E., & Hallet, J. I. (2023) · Expert Review of Anticancer Therapy · doi:10.1080/14737140.2023.2207829 · Cited by 12 · see citing works
Zhang, C., Jiang, S.-J., Cao, J., Xu, Y. J., Wang, X., Li, R., & Miao, Z. (2024) · Frontiers in Microbiology · doi:10.3389/fmicb.2024.1420167 · Cited by 11 · see citing works
Functioning neuroendocrine tumors (NET): Minimum requirements for a NET specialist
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Self-citationGender Differences in Lung Neuroendocrine Tumors: A Single-Center Experience
Liccardi, A., Colao, A., & Modica, R. (2024) · Neuroendocrinology · doi:10.1159/000539412 · Cited by 11 · see citing works
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Impact of treatment on quality of life in neuroendocrine neoplasm survivors
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Self-citationSalvia, A. L., Modica, R., Spada, F., & Rossi, R. E. (2024) · Endocrine · doi:10.1007/s12020-024-04129-z · Cited by 6 · see citing works
Self-citationEditorial: Neuroendocrine tumors: the road to precision medicine
Salvia, A. L., Giuffrida, D., & Modica, R. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1253319 · Cited by 6 · see citing works
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How the diffuse neuroendocrine system shapes health, homeostasis, and cancer
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Efficiency and Safety of Targeted Alpha Therapy in Metastatic Neuroendocrine Tumors
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Peshin, S., Modi, S., Babakhanlou, R., & Arshad, J. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14186522 · Cited by 3 · see citing works
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The association between non-HDL cholesterol and high-grade pancreatic neuroendocrine neoplasms
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Tumor Growth Rate in Neuroendocrine Neoplasms: An Additional Tool for Treatment Strategies?
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Innovative approaches in predicting outcomes for rectal neuroendocrine tumors
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Authorship of Italian medical literature on neuroendocrine neoplasms: any gender gap?
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Self-citationAppendicular Neuroendocrine Tumours: An Unusual Cause of Hydronephrosis
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Future Trends in NEN Care: QoL and Multidisciplinary Care
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Future Trends in NEN Care: QoL and Multidisciplinary Care
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Flushing: Neuroendocrine Mechanisms and a Structured Diagnostic Approach
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Self-citation
- Authors
- Modica, R., Liccardi, A., Minotta, R., Cannavale, G., Benevento, E., & Colao, A.
- Affiliations
- Federico II University Hospital (IT)
- Corresponding author
- Modica, Roberta
- ORCID
- Venue
- Expert Review of Endocrinology & Metabolism
- Publisher
- Informa UK Limited
- Published
- 2022-07-13
- Volume
- 17
- Issue
- 5
- Pages
- 389-403
- ISSN
- 1744-6651 (ISSN-L)
- 1744-8417
- OpenAlex
- W4285024223
- Cited by
- 37
- References
- 114
- Citations by year
- 2026: 3 · 2025: 13 · 2024: 13 · 2023: 6 · 2022: 2
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Review of Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- funding
- Topics
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Neurology › Neuroblastoma Research and Treatments
- Keywords
- neuroendocrine neoplasms, gastroenteropancreatic neuroendocrine tumors, lung neuroendocrine tumors, somatostatin analogues, everolimus, sunitinib, peptide receptor radionuclide therapy, chemotherapy, targeted therapy, treatment sequencing, drug toxicity, treatment resistance, treatment algorithm
- MeSH terms
- Everolimus, Humans, Pancreatic Neoplasms, Somatostatin, Neuroendocrine Tumors
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