Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2450-2459
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2450
Appropriateness of systemic treatments in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors
Jonathan R Strosberg, George A Fisher, Al B Benson, Lowell B Anthony, Bulent Arslan, John F Gibbs, Edward Greeno, Renuka V Iyer, Michelle K Kim, William J Maples, Philip A Philip, Edward M Wolin, Dasha Cherepanov, Michael S Broder
Jonathan R Strosberg, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
George A Fisher, Department of Medicine, Division of Oncology, Stanford University Medical Center, Stanford, CA 94305, United States
Al B Benson, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, United States
Lowell B Anthony, Department of Internal Medicine, Division of Medical Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, United States
Bulent Arslan, Rush University Medical Center, Chicago, IL 60612, United States
John F Gibbs, Department of Surgery, University at Buffalo - State University of New York, Buffalo, NY 14260, United States
Edward Greeno, Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN 55455, United States
Renuka V Iyer, Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, United States
Michelle K Kim, Department of Medicine, Gastroenterology Mount Sinai School of Medicine, New York, NY 10029, United States
William J Maples, Mission Health System, Asheville, NC 28801, United States
Philip A Philip, Department of Oncology, Karmanos Cancer Institute, Detroit, MI 48201, United States
Edward M Wolin, Department of Internal Medicine, Division of Medical Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, United States
Dasha Cherepanov, Michael S Broder, Partnership for Health Analytic Research, LLC, Beverly Hills CA 90212, United States
Author contributions: Strosberg JR, Fisher GA, Benson AB, Cherepanov D and Broder MS designed the research, interpreted the findings, and drafted the manuscript; Strosberg JR, Fisher GA and the rest of members of the GEPNET Treatment Consensus Panel; Anthony LB, Arslan B, Gibbs JF, Greeno E, Iyer RV, Kim MK, Maples WJ, Philip PA, Wolin EM performed the research and contributed to interpretation of the findings and review of this research.
Supported by Grants from Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936-1080, United States.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael S Broder, MD, MSHS, Partnership for Health Analytic Research, LLC, 280 South Beverly Drive, Suite 404, Beverly Hills, CA 90212, United States. mbroder@pharllc.com
Telephone: +1-310-8589555 Fax: +1-310-8589552
Received: March 26, 2014
Peer-review started: March 26, 2014
First decision: March 29, 2014
Revised: July 31, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: February 28, 2015
Processing time: 339 Days and 15.2 Hours
Core Tip

Core tip: Using the RAND/UCLA modified Delphi process, physician experts obtained consensus on the appropriateness of various medical therapies in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors. Consensus statements were: (1) it is appropriate to use somatostatin analogs as first-line therapy in patients with hormonally-functional tumors and may be appropriate in asymptomatic patients; (2) it is appropriate to use everolimus, sunitinib, or cytotoxic chemotherapy as first-line therapy in patients with symptomatic or progressive tumors; and (3) beyond first-line, these same agents can be used. In patients with uncontrolled secretory symptoms, octreotide-LAR can be titrated up to 60 mg/4 wk or up to 40 mg/3 or 4 wk.