Liver-Directed Therapy for Gastroenteropancreatic NETs in the Era of Peptide Receptor Radionuclide Therapy

Abstract

AbstractGastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a heterogeneous group of tumors. Current treatment algorithms for these tumors are complex and often require a multidisciplinary approach. Recently, peptide receptor radionuclide therapy (PRRT) was granted Food and Drug Administration approval, making this treatment widely available in the United States. PRRT is now another therapeutic option for patients with GEP-NETs. To date there are no consensus guidelines about how to sequence multiple treatment options. Moreover, there is concern of potential liver toxicity when PRRT is used before or after liver-directed therapies (LDTs). In this review, we describe the characteristics of the most commonly used LDT and their potential interactions with PRRT, as well as specific clinical scenarios that are relevant when deciding on the use of LDT. We also review the limited case series that have been published involving patients treated with different combinations of LDT and PRRT. Finally, we discuss some of the future directions for GEP-NET treatments.