Información del artículo
Los tumores neuroendocrinos gastroenteropancreáticos (TEGEP) son una entidad clínica poco frecuente. Dado que el único tratamiento curativo es la resección quirúrgica completa, es necesario realizar un diagnóstico temprano. La medición de marcadores neuroendocrinos específicos y la expresión de receptores para la somatostatina por estos tumores ayudan a confirmar la sospecha clínica. Aun en los casos en los que la cirugía no es curativa, puede disminuir el volumen tumoral y la hipersecreción hormonal, resolver las complicaciones mecánicas, facilitar la respuesta posterior al tratamiento médico y disminuir sus complicaciones, mejorar la calidad de vida y la supervivencia y, por último, identificar marcadores histológicos de mal pronóstico. La expresión en los TEGEP de diversos subtipos de receptores para la somatostatina permite el tratamiento con análogos de somatostatina de acción prolongada como el octreótida LAR y el lanreótido Autogel. Ambos fármacos tienen efecto antisecretor, antiproliferativo (citostático) y citotóxico (apoptosis), producen una mejoría clínica y bioquímica, una estabilización tumoral e incluso, en algunos casos, una regresión tumoral. Además, pueden actuar como vehículo de isótopos radiactivos y permiten una radioterapia específica y eficaz. El interferón-α está indicado en pacientes con resistencia a análogos de somatostatina, especialmente en carcinoides. La quimioterapia debe considerarse bien en TEGEP poco diferenciados o en casos de enfermedad progresiva sin respuesta a otros tratamientos. Siempre debe considerarse el riesgo-beneficio de utilizar tratamientos agresivos en pacientes que, a pesar de tener enfermedad diseminada, suelen tener supervivencias prolongadas.
Palabras clave:
Tumores neuroendocrinos gastroenteropancreáticos
Tratamiento farmacológico
Análogos de somatostatina
Digestive neuroendocrine tumors are a rare clinical entity. Because surgery is the only curative therapy, early diagnosis is required. Clinical suspicion is usually confirmed by specific serological neuroendocrine markers and tissue expression of somatostatin receptors. Even when surgery is not curative, it can reduce tumor volume and hormone hypersecretion, resolve mechanical complications and help subsequent response to medical treatment, improve quality of life and survival, and identify histological markers of poor prognosis.
Expression of different subtypes of somatostatin receptors in digestive neuroendocrine tumors allows treatment with somatostatin analogs such as Octreotide LAR and Lanreotide Autogel. Both treatments are anti-secretory, anti-proliferative (cytostatic) and cytotoxic (apoptosis), induce clinical and biochemical remission, stabilize the tumor, and can even produce tumor regression in some cases. These agents can also play a role as isotope carriers, allowing specific and effective radiotherapy.
Interferon-alpha is indicated in patientswith somatostatin analog resistance, especially in carcinoids. Chemotherapy should be considered in poorly differentiated tumors or in patients with progressive disease and no response to somatostatin analogs and/or interferon. The risk-benefit ratio of using aggressive therapy should always be considered in patients who, despite having disseminated disease, usually have prolonged survival.
Key words:
Gastroenteropancreatic neuroendocrine tumors
Pharmacological treatment
Somatostatin analogs
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