A CASE REPORT OF ADVANCED PANCREATIC NEUROENDOCRINE TUMOR TREATED WITH CHEMOTHERAPY FOR CISPLATIN CONTAINING RESIMEN FOLLOWED BY EVEROLIMUS IN COMBINATION WITH OCTREOTIDE LAR

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Abstract

Pancreatic neuroendocrine tumor (P-NET) accounts for less than 5% of all pancreatic tumors. Treatment options for advanced P-NET are somewhat limited. At this time, the standard therapy for advanced P-NET is not exist. Everolimus, which targets the mammalian target of rapamycin (mTOR), has recently been approved for patients with advanced P-NETs. We herein present a case of P-NET treated with chemotherapy for the cisplatin–etoposide resimen followed by everolimus in combination with octreotide LAR. A 71-year-old female was referred to our hospital with tumor in the tail of the pancreas with the multiple liver metastasis. The dynamic study of computed tomography (CT) scan showed hypervascular tumors on the early phase in the pancreatic tail and liver, both of which were the same enhanced pattern. No hormonal abnormalities demonstrated. Endosonography-guided fine needle aspiration (EUS-FNA) was underwent to the pancreatic lesion. The cytology and immunological examination suggested both synaptophysin and chromogranin A positive, which led to the diagnosis with class III neuroendocrine tumor. Even histological examination was not carried out, she was diagnosed with stageIV P-NET because imaging studies had already revealed liver metastasis. She began to be treated with systemic chemotherapy of cisplatin–etoposide resimen analogous to that used for small-cell lung cancer and octreotide LAR 30 mg, a long acting somatostatin analog, was given as a intramuscular (IM) injection every 28 days. After recieving two courses cisplatin–etoposide resimen, the CT scan showed a marked increase in the tumor size in the liver and found to be progressive disease. Cisplatin–etoposide resimen were switched to everolimus 10 mg PO daily with octreotide LAR 30 mg IM every 28 days continued. At the time of submission of this abstract, she had been still treated with everolimus–octreotide LAR.

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