Patients & Caregivers

How GEP NE Tumors Are Treated (Treatment)

GEP NE tumors are treated with a variety of approaches, including surgery and medical therapies such as somatostatin analogues, interferon therapy, chemotherapy and radiation therapy.

These treatments are listed in order from most common to less common.

• Surgery. Surgery is performed whenever possible to remove the tumor. If the tumor can be removed completely, it can potentially cure the disease. Even if the entire tumor cannot be removed, "debulking" surgery may be considered to eliminate as much of the tumor as possible. This can help relieve some symptoms, sometimes for a long period, since many tumors are slow growing.
• Embolization. Embolization is performed in some patients with liver metastases. This procedure mechanically blocks the blood supply to liver metastases, causing them to shrink and become less active. It is usually performed by an interventional radiologist and can be performed either with or without chemotherapy.

• Somatostatin analogues. In addition to its use as a diagnostic tool, the somatostatin analogue octreotide can be used to alleviate symptoms brought about by the high amounts of various hormones produced by neuroendocrine tumor cells.

  The hormone somatostatin inhibits the effects of many other hormones in the body. It does this by binding to somatostatin receptors on tumor cells, which prevents the release of hormones. Somatostatin analogues act in the same way as somatostatin.

  Somatostatin analogues are most useful in reducing the symptoms, such as severe diarrhea and flushing, of functional GEP tumors (e.g. metastatic carcinoid tumors and VIPomas).

• Alpha-interferon. Interferon is a natural substance produced by the white blood cells in the body that fight infection. It may also stimulate the immune system to fight cancer. One type of interferon-alpha-interferon-seems to inhibit the release of hormones from tumor cells and also may be able to control the growth of GEP NE tumors.¹ However, interferon may cause side effects, such as flu-like symptoms and extreme fatigue.

  Some, but not all, studies suggest that the combination of alpha-interferon and somatostatin analogues may be more effective than using either therapy alone.^2-4

• Chemotherapy. A number of chemotherapy drugs have been used to treat GEP NE tumors. Many standard chemotherapy regimens utilize drug combinations. While useful in selected patients, the overall success of such regimens has been mixed, and potentially more effective and less toxic treatments are actively being investigated.^5-10
• Radiation therapy. X-rays or other types of radiation can be used to treat GEP NE tumors.
• External beam radiation therapy, in which a machine is used to send a beam of radiation to kill tumor cells, is sometimes used to alleviate symptoms of the disease, and is particularly useful in patients with bone metastases.

Resources

If you have more questions about GEP NE tumors, you should first speak with your healthcare professional because he or she understands your specific medical needs. The Internet is another good source of information about GEP NE tumors and offers ways to connect with other patients and families to share experiences, resources and support.

Certain links on this site lead to resources located on servers maintained by third parties over whom Novartis has no control. As such, Novartis Pharmaceuticals Corporation makes no representation as to the accuracy or any other aspect of the information contained on such servers.

The Carcinoid Cancer Foundation
Offers research and education on carcinoid tumors.

http://www.carcinoid.org

National Organization for Rare Disorders (NORD)
NORD includes various types of GEP NE tumors in its rare-disease database and will email or fax you a full report for a nominal fee

http://www.raredisease.org

Society for Endocrinology
A professional association whose membership is open to anyone working in an endocrine-related field anywhere in the world and at any stage in his/her career. Membership benefits include a newsletter, professional meetings, training and networking.

http://www.endocrinology.org

Articles

Benali N, et al. Somatostatin receptors. Digestion. 2000;62:27-32.

De Vries H, Verschueren RCJ, Willemse PHB, et al. Diagnostic, surgical and medical aspect of the midgut carcinoids. Cancer Treat Rev. 2002;28:11-25.

Kulke MH. Neuroendocrine tumors: clinical presentation and management of localized disease. Cancer Treat Rev. 2003;29:363-370.

Kulke MH and Mayer RJ. Carcinoid tumors. N Engl J Med. 1999;340:858-868.

Oberg K. Neuroendocrine gastrointestinal tumors. Ann Oncol. 1996;7:453-463.

Books

Alexander HR and Jensen RT. Pancreatic endocrine tumors. En: DeVita VT, et al, eds. Cancer Principles and Practice. 6th ed. Philadelphia:Lippincott Williams &Wilkins;2001:1788-1813.

Jensen RT and Doherty GM. Carcinoid tumors and the carcinoid syndrome. En: DeVita VT, et al, eds. Cancer Principles and Practice.6th ed. Philadelphia:Lippincott Williams &Wilkins;2001:1813-1833.

Web Sources

The Carcinoid Cancer Foundation,

www.carcinoid.org

Touroutoglou N, Arcenas A, Ajani J, MD Anderson Cancer Center, Houston. Neuroendocrine tumors of the gastrointestinal tract: comprehensive review,

http://www.cancernetwork.com/textbook/morev18.htm

Arnold R. Diagnosis and management of neuroendocrine tumors.

http://www.medscape.com/viewarticle/420088?src+search

References

1. Oberg K. Interferon in the management of neuroendocrine GEP-tumors. Digestion. 2000;62(suppl 1);92-97.
2. Joensun H, Katka K, Kujari H. Dramatic response of a metastatic carcinoid tumor to a combination of interferon and octreotide. Acta Endocrinol (Copenh). 1992;126:184-185.
3. Janson ET, Oberg K. Long-term management of the carcinoid syndrome. Treatment with octreotide alone and in combination with alpha-interferon. Acta Oncol. 1993;32:225-229.
4. Frank M, Klose KJ, Wied M, et al. Combination therapy with octreotide and alpha-interferon: Effect of tumor growth in metastatic endocrine gastroenteropancreatic tumors. Am J Gastroenterol. 1999;94:1382-1387.
5. Moertel C, Hanley J. Combination chemotherapy trials in metastatic carcinoid tumor and the malignant carcinoid syndrome. Cancer Clin Trials. 1979;2:327-334.
6. Engstrom P, Lavin P, Moertel C, Folsch E, Douglass H. Streptozocin plus fluorouracil versus doxorubicin therapy for metastatic carcinoid tumor. J Clin Oncol. 1984;2:1255-59.
7. Moertel C, Lefkopoulo M, Lipsitz S, Hahn R, Klaassen D. Streptozocin-doxorubicin, stretpozocin-fluorouracil, or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med. 1992;326:519-23.
8. Cheng P, Saltz L. Failure to confirm major objective antitumor activity of streptozocin and doxorubicin in the treatment of patients with advanced islet cell carcinoma. Cancer. 1999;86:944-8.
9. Bukowski R, Tangen C, Peterson R, et al. Phase II trial of dimethyltriazenoimidazole carboxamide in patients with metastatic carcinoid. A Southwest Oncology Group study. Cancer. 1994;73:1505-8.
10. Ramanthan R, Cnaan A, Hahn R, Carbone P, Haller D. Phase II trial of dacarbazine (DTIC) in advanced pancreatic islet cell carcinoma. Study of the Eastern Cooperative Oncology Group E-6282. Ann Oncol. 2001;12:1139-43.

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