Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs), although curable when localized, frequently metastasize and require management with systemic therapies, including somatostatin analogues, peptide receptor radiotherapy, small-molecule targeted therapies, and chemotherapy. Although effective fo...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-12-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/14/24/6114 |
| _version_ | 1797461120675479552 |
|---|---|
| author | Chanjuan Shi Michael A. Morse |
| author_facet | Chanjuan Shi Michael A. Morse |
| author_sort | Chanjuan Shi |
| collection | DOAJ |
| description | Gastroenteropancreatic neuroendocrine tumors (GEP-NETs), although curable when localized, frequently metastasize and require management with systemic therapies, including somatostatin analogues, peptide receptor radiotherapy, small-molecule targeted therapies, and chemotherapy. Although effective for disease control, these therapies eventually fail as a result of primary or secondary resistance. For small-molecule targeted therapies, the feedback activation of the targeted signaling pathways and activation of alternative pathways are prominent mechanisms, whereas the acquisition of additional genetic alterations only rarely occurs. For somatostatin receptor (SSTR)-targeted therapy, the heterogeneity of tumor SSTR expression and dedifferentiation with a downregulated expression of SSTR likely predominate. Hypoxia in the tumor microenvironment and stromal constituents contribute to resistance to all modalities. Current studies on mechanisms underlying therapeutic resistance and options for management in human GEP-NETs are scant; however, preclinical and early-phase human studies have suggested that combination therapy targeting multiple pathways or novel tyrosine kinase inhibitors with broader kinase inhibition may be promising. |
| first_indexed | 2024-03-09T17:14:53Z |
| format | Article |
| id | doaj.art-ffdd2b1b434345b6ba9e24211f451f6e |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T17:14:53Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-ffdd2b1b434345b6ba9e24211f451f6e2023-11-24T13:46:24ZengMDPI AGCancers2072-66942022-12-011424611410.3390/cancers14246114Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine TumorsChanjuan Shi0Michael A. Morse1Department of Pathology, Duke University Medical Center, Durham, NC 27710, USADepartment of Medicine, Duke University Medical Center, Durham, NC 27710, USAGastroenteropancreatic neuroendocrine tumors (GEP-NETs), although curable when localized, frequently metastasize and require management with systemic therapies, including somatostatin analogues, peptide receptor radiotherapy, small-molecule targeted therapies, and chemotherapy. Although effective for disease control, these therapies eventually fail as a result of primary or secondary resistance. For small-molecule targeted therapies, the feedback activation of the targeted signaling pathways and activation of alternative pathways are prominent mechanisms, whereas the acquisition of additional genetic alterations only rarely occurs. For somatostatin receptor (SSTR)-targeted therapy, the heterogeneity of tumor SSTR expression and dedifferentiation with a downregulated expression of SSTR likely predominate. Hypoxia in the tumor microenvironment and stromal constituents contribute to resistance to all modalities. Current studies on mechanisms underlying therapeutic resistance and options for management in human GEP-NETs are scant; however, preclinical and early-phase human studies have suggested that combination therapy targeting multiple pathways or novel tyrosine kinase inhibitors with broader kinase inhibition may be promising.https://www.mdpi.com/2072-6694/14/24/6114somatostatin analogtyrosine kinase inhibitormTOR inhibitorpeptide receptor radiotherapy |
| spellingShingle | Chanjuan Shi Michael A. Morse Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors Cancers somatostatin analog tyrosine kinase inhibitor mTOR inhibitor peptide receptor radiotherapy |
| title | Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors |
| title_full | Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors |
| title_fullStr | Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors |
| title_full_unstemmed | Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors |
| title_short | Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors |
| title_sort | mechanisms of resistance in gastroenteropancreatic neuroendocrine tumors |
| topic | somatostatin analog tyrosine kinase inhibitor mTOR inhibitor peptide receptor radiotherapy |
| url | https://www.mdpi.com/2072-6694/14/24/6114 |
| work_keys_str_mv | AT chanjuanshi mechanismsofresistanceingastroenteropancreaticneuroendocrinetumors AT michaelamorse mechanismsofresistanceingastroenteropancreaticneuroendocrinetumors |