By Anna Greene, PhD, NETRF Director of Research
For many patients newly diagnosed with small, nonfunctioning pancreatic neuroendocrine tumors (PanNETs), active surveillance (AS) with regular imaging and monitoring may be recommended, especially when tumors are less than 2 cm in size, do not cause symptoms, and appear low-grade.
But what if that approach sometimes isn’t enough?
A recent study published in Pancreas by Dr. Maria Grazia Maratta and colleagues challenges the idea that small PanNETs can simply be watched. The research raises an important question: could early medical treatment with somatostatin analogs (SSAs), a class of drugs already known to help slow tumor growth in advanced neuroendocrine tumors, help some patients with small tumors avoid progression, spread, or future complications?
The answer, from this team’s experience, seems to be yes.
What Was the Study About?
Researchers examined 72 patients with newly diagnosed, small (≤2 cm), nonfunctioning, well-differentiated PanNETs, tumors that did not produce hormones and therefore did not cause symptoms.
- 31 patients chose SSA therapy (monthly injections of octreotide or lanreotide).
- 41 patients opted for active surveillance, with regular scans and no initial treatment.
Importantly, all patients were not candidates for surgery (due to medical risks or personal choice) and were carefully monitored by a multidisciplinary tumor board.
What Did They Find?
Over a median follow-up of nearly 4.5 years:
- Zero patients on SSA therapy experienced tumor progression or disease-related death.
- In contrast, over 1 in 5 patients (21.9%) in the surveillance group experienced tumor progression or died.
- Some primary tumors grew in size.
- Two patients developed metastases.
- Two died as a direct result of disease progression.
Moreover, some SSA-treated patients saw their tumors shrink, with one achieving complete disappearance of their tumor.
Why Does This Matter?
Some PanNETs may appear to grow slowly at first, but some can surprise us.
Current guidelines suggest surveillance can be reasonable for some tumors under 2 cm. And often, it is. But this study shows that even small tumors can behave unpredictably, with some progressing, spreading, or even becoming deadly.
What’s new here is that SSA therapy may provide a safe middle ground between surgery and watchful waiting.
Is SSA Treatment Safe?
Yes. The most common side effects reported were mild and manageable:
- Injection-site reactions
- Occasional diarrhea
- One patient stopped treatment due to fatigue
No severe complications were reported, and the majority of patients tolerated the therapy well. However, little is known about long-term SSA use, and further research is needed.
What’s Next?
While this study is promising, it’s not the final word. It was a retrospective, single-center study without a surgical comparison group. We need larger, prospective clinical trials to determine who benefits most from early SSA therapy and how long treatment should last.
But the key takeaway is this: SSA treatment may offer real protection for some patients whose tumors are “small but sneaky.”
NETRF-funded research has shown that PanNET biomarkers, DAXX, ATRX, and ALT, are more dependable indicators of aggressive behavior and recurrence than size or grade alone. For instance, tumors that test positive for ALT or show ATRX/DAXX loss have significantly lower recurrence-free survival, even if they are smaller than 2 cm. Learn more here. Additionally, further research funded by NETRF has created a clinical test to detect ALT, enabling its use in clinical decision-making. Learn more here.
Our Message to Patients and Caregivers
Every NET is different, and so is every patient.
At NETRF, we’re encouraged by this research. It supports a future where patients and care teams have more choices—not just “surgery or nothing”—but an evidence-based option for those seeking proactive, non-surgical care.
If you or a loved one is managing a small pancreatic NET, talk to your medical team about the full range of options, including the potential role of somatostatin analogs. Together, you can make the best plan, one that matches the tumor’s biology and your goals.
As you continue to explore treatment options and navigate life with NETs, we invite you to check out our NETWise podcast. One episode we especially recommend is Finding Happiness While Living with Neuroendocrine Cancer—a heartfelt conversation filled with practical insights and personal reflections on creating joy, meaning, and balance while living with this disease. It’s a powerful reminder that thriving with NETs is possible.
Related Research News
Beyond Size: Rethinking How We Manage Small Pancreatic Neuroendocrine Tumors