Systemic therapies in patients with advanced well-differentiated pancreatic neuroendocrine tumors (PanNETs): When cytoreduction is the aim. A critical review with meta-analysis

摘要: Abstract Introduction Cytoreduction is sometimes an important aim of systemic anti-tumor therapies in well-differentiated pancreatic neuroendocrine tumors (PanNETs). As there not a gold standard treatment for these this field, we conducted literature review order to identify objective criteria choice. Materials and methods We critically reviewed performed meta-analysis all published clinical studies patients with unresectable PanNETs, selecting only those articles which reported tumor shrinkage (TS) waterfall plot (WP). Tumor downsizing ≥10% was considered as response. Results selected 17 out 2758 studies, comprising 1118 response WP. Proliferation index, burden were heterogeneous. Chemotherapy alone (mainly, capecitabine/temozolomide) or combination showed the best results, TS ranging from 65% 93%. Peptide receptor radionuclide therapy combined chemotherapy (Chemo-PRRT) sunitinib appeared promising by inducing significant proportion (93% 60%, respectively). Time two trials. No clear and/or biological predictive factors emerged. Conclusion Based on used our retrospective analysis, have main cytoreductive impact. However no conclusions regarding either specific regimen can be drawn. Furthermore, population selection choice may influence. Further analysis should also potential biomarkers responses, design future prospective interventional trials enrolling more homogenous populations advanced PanNETs.