Chemotherapy
There are a number of treatments for Neuroendocrine Cancer – treatment choice is important to ensure it is appropriate and available for you and the Neuroendocrine Cancer you have.
Treatment choice for Neuroendocrine Cancer, depends on:
- where it is (primary site)?,
- what stage it is? (has it spread ? and where ?)
- how slowly or rapidly is it growing (grading)?,
- is it well or poorly differentiated (how abnormal have the cells become)?,
- is it functioning or non-functioning (is it producing normal or excess levels of hormones)?,
- is it causing symptoms or not – if yes, what type?,
- is there a genetic link or not?
Other factors include ; other health conditions, age, access to expert & experienced healthcare teams, availability of appropriate treatments, responses to any previous treatment and your informed decision-making and/or consent.
Standard chemotherapy works on targeting rapidly dividing and growing cells – this includes both healthy cells and cancer cells.
It can cause damage to some of the healthy cells in your body. However, while normal cells have the ability to repair themselves and recover – cancer cells in general, do not. Despite this ability for recovery and repair of normal cells, it is important to ensure that chemotherapy is only used when and where it may be most effective and least harmful.
Most Neuroendocrine Tumours (NETs) are Grade 1 or 2 — where overall less than 20% of tumour cells are active – meaning they have a low to moderate rate of cell division and growth. They retain certain features of the normal cell they should be – are ‘well-differentiated”.
Grade 3 NETs have a higher rate of cell division and growth – above 20%, but are also ‘well-differentiated” and may not be as aggressive in nature as Grade 3 poorly-differentiated cells. Almost all Neuroendocrine Carcinomas (NECs) are Grade 3 – where the rate of cell division and growth is more than 20%, often more than 55%.
In NECs the cells have become very abnormal, losing almost all features of the original cell they were meant to be – they are ‘poorly-differentiated’. Therefore, whilst chemotherapy is often a key treatment choice for Grade 3 Neuroendocrine Carcinomas (NECs) it is less commonly chosen for Neuroendocrine Tumours (NETs). N.B. Exceptions occur.
Targeted Molecular Therapies
can be given orally (in tablets) or Intravenously (through a vein) to slow tumour growth or try to reduce tumour size.
They are drugs or other substances that work against cancer by interfering with specific molecules that are involved in the growth, progression, and spread of cancer. Many different targeted therapies have been approved for use in cancer treatment. These therapies include hormone therapies, signal transduction inhibitors, gene expression modulators, apoptosis inducers, angiogenesis inhibitors, immunotherapies, and toxin delivery molecules. Further information on these different types of therapy can be found at CRUK.
Current Targeted Molecular Therapies that are used in Neuroendocrine Cancers –treat ‘well-differentiated’ Grade 1-2 Neuroendocrine Tumours (NETs) – and include:
- Everolimus (Afinitor) – which is a targeted drug that blocks mTOR, a protein in cells that normally helps them grow and divide. Everolimus may also stop tumors from developing new blood vessels, which can help limit their growth.
Everolimus is currently licensed within the UK to treat inoperable non-functioning, well differentiated, Grade 1-2 Neuroendocrine Tumours that start in the pancreas, gastrointestinal system or lung(s) and are showing signs of ongoing growth and / or spread.
- Sunitinib (Sutent) is a targeted drug that works by stopping tumours from developing new blood vessels (angiogenesis) and also blocking growth-stimulating proteins in the cancer cell itself.
Sunitinib is currently licensed within the UK to treat inoperable non-functioning, well-differentiated, Grade 1-2 Neuroendocrine Tumours that start in the pancreas and is showing signs of ongoing growth and / or spread.