Radiopharmaceuticals and Systemic Therapies for Neuroendocrine Tumors

Neuroendocrine neoplasms are increasing in incidence and prevalence due to improved imaging detection of smaller tumors, endoscopies, increased awareness, and a relatively indolent disease course leading to improved survival. Neuroendocrine neoplasms are diverse with distinct characteristics depending upon the primary site of origin, tumor grade, stage, and other factors. The decision regarding the optimal treatment strategy is largely determined by the grade of the pathology specimen. Another important consideration is the identification of functional tumors. Identification of functional hormonal syndromes associated with NETs may influence treatment and workup and may necessitate the involvement of endocrinology. Initiation of systemic therapies for neuroendocrine neoplasms should be done after appropriate imaging, staging, and multidisciplinary discussion of treatment options including the role of surgical resection, locoregional therapy, and radionuclide therapy. Presented here is a broad overview of the systemic therapies available to patients with neuroendocrine tumors with a focus on the radionuclide therapies.