Non-Interventional Management of Advanced Pancreatic Neuroendocrine Neoplasms in Patients with von Hippel-Lindau Disease

Abstract

Von Hippel-Lindau (VHL) is a rare autosomal dominant hereditary cancer predisposition syndrome. Patients with VHL have a high risk for developing retinal and central nervous system hemangioblastoma, pheochromocytoma, renal cell carcinoma, and pancreatic neuroendocrine neoplasms (PNEN). About a fifth of patients with VHL will develop PNEN, and only a tenth of them will develop metastatic or unresectable (advanced) PNEN requiring medical intervention. In this review, we performed a literature search for studies, written in English, on the medical interventions for VHL-related localized and advanced PNENs and their clinical outcomes. We detail the various medical interventions for this rare group of patients, including their mode of action and potential efficacy and toxicity. Finally, based on the current literature, we delineate a possible management algorithm for patients with VHL and advanced PNEN. We can conclude that data on the efficacy of various vascular endothelial growth factor (VEGF) receptor inhibitors, and on the efficacy of belzutifan, a novel hypoxia-inducible factor 2 inhibitor, for the management of advanced PNEN in VHL, are scarce. Hence, deduction from the management of sporadic PNEN is required, and is implemented in the proposed management algorithm provided within this review.

Keywords: HIF inhibitor; VEGF receptor inhibitor; metastasis; pancreatic neuroendocrine neoplasms; von Hippel–Lindau.

Figure 1

Advanced vPNEN treatment algorithm according to patient specific characteristics. Treatment decision is based on efficacy of therapy as studied in patients with vPNET followed by known efficacy regarding other clinical manifestations or functionality of the vPNEN. CAPTEM—capecitabine and temozolomide, PRRT—peptide receptor radionuclide therapy, RCC- renal cell carcinoma, SSA-somatostatin analogues, VEGFR—vascular endothelial growth factor receptor, vPNEN—VHL-related pancreatic neuroendocrine neoplasm.