The efficacy of streptozotocin in managing pancreatic neuroendocrine neoplasms - A systematic review

Giulia Arrivi; Nicola Fazio; Salvatore Tafuto; Massimo Falconi; Carlo Carnaghi; Davide Campana; Maria Rinzivillo; Francesco Panzuto

doi:10.1016/j.ctrv.2025.102899

The efficacy of streptozotocin in managing pancreatic neuroendocrine neoplasms - A systematic review

Cancer Treat Rev. 2025 Mar:134:102899. doi: 10.1016/j.ctrv.2025.102899. Epub 2025 Feb 12.

Authors

Giulia Arrivi¹, Nicola Fazio², Salvatore Tafuto³, Massimo Falconi⁴, Carlo Carnaghi⁵, Davide Campana⁶, Maria Rinzivillo⁷, Francesco Panzuto⁸

Affiliations

¹ Oncology Unit Department of Clinical and Molecular Medicine Sapienza University of Rome Sant'Andrea University Hospital ENETS Center of Excellence Rome Italy.
² Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS Milan IT Italy.
³ Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples 80131, Italy.
⁴ Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy.
⁵ Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Misterbianco, Catania 95045, Italy.
⁶ Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
⁷ Digestive Disease Unit, Department of Surgical-Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy.
⁸ Digestive Disease Unit, Department of Surgical-Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy. Electronic address: francesco.panzuto@uniroma1.it.

PMID: 39954330
DOI: 10.1016/j.ctrv.2025.102899

Abstract

Pancreatic neuroendocrine tumors (pan-NETs) represent a highly heterogeneous and complex pathology, with therapeutic management and prognosis influenced by several biological and clinical characteristics. Chemotherapy, including regimens based on capecitabine and temozolomide (CAPTEM) or the combination of streptozotocin and 5-fluorouracil (STZ-5FU), is indicated for rapidly growing, symptomatic, or high-burden disease requiring swift cytoreduction. Historical studies provide scientific evidence for the STZ-5FU regimen, often retrospective and frequently analyzing small series. Despite these limitations, the efficacy of this treatment is well-established, and it is included in all guidelines as a therapeutic option. This systematic review aims to gather scientific evidence on using STZ-based chemotherapy to assess its real impact in managing well-differentiated metastatic or unresectable pan-NETs.

Keywords: Alkylating agents; Chemotherapy; Guidelines; Neuroendocrine tumors; Streptozotocin.

Publication types

Systematic Review
Review

MeSH terms

Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
Humans
Neuroendocrine Tumors* / drug therapy
Neuroendocrine Tumors* / pathology
Pancreatic Neoplasms* / drug therapy
Pancreatic Neoplasms* / pathology
Streptozocin* / administration & dosage
Streptozocin* / therapeutic use

Substances

Streptozocin