Neuroendocrine Tumors Drug Summary

Last updated: 05 February 2026
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Cancer Immunotherapy/Immunomodulating Agents

Drug Dosage Remarks
Interferon alpha
(Interferon alfa, Interferon α) 		5 MIU SC 24 hourly every other day
Dose range: 3-9 MIU SC 24 hourly 		Adverse Reactions
  • CNS effects (fever, fatigue, headache); GI effects (anorexia, nausea/vomiting); Other effects (myalgia, rigor, chills)
Special Instructions
  • Dose reduction, interruption, or discontinuation may be required according to individual safety or tolerability
  • Avoid use in patients with history of hypersensitivity, severe renal dysfunction or creatinine clearance (CrCl) <50 mL/min, decompensated hepatic disease, autoimmune disease, immunosuppressed conditions, pre-existing psychiatric condition especially depression or severe psychiatric disorder
    • Discontinue use if acute, serious hypersensitivity reactions develop
  • Use with caution in patients with history of pulmonary disease (eg chronic obstructive pulmonary disease [COPD]), diabetes mellitus (DM) prone to ketoacidosis, coagulation disorder, severe myelosuppression, chronic hepatitis B with evidence of decreasing hepatic synthetic function, congestive heart failure (CHF), myocardial infarction and/or previous or current arrhythmic disorders, acquired immunodeficiency syndrome (AIDS)-related Kaposi’s sarcoma, pre-existing psoriatic disease or sarcoidosis, dental and periodontal disorders
  • Monitor patients for liver function abnormalities, pulmonary function impairment, development of psychiatric or CNS problems
  • Prior to or during the course of treatment, monitor ECG in patients with pre-existing cardiac abnormalities and/or advanced stages of cancer, visual exams especially in patients with DM or hypertension, thyroid stimulating hormone levels, lipid levels
    • Discontinue use in patients who develop new or worsening ophthalmologic disorders
  • Maintain adequate hydration as hypotension due to fluid depletion may occur

Targeted Cancer Therapy

Drug Dosage Remarks
Belzutifan 120 mg PO 24 hourly until disease progression or unacceptable toxicity Adverse Reactions
  • GI effect (nausea); CNS effects (headache, dizziness); Hematologic effects (decreased hemoglobin, anemia); Metabolic effects (increased creatinine, glucose); Other effect (fatigue)
Special Instructions
  • Monitor hemoglobin level and oxygen saturation
Cabozantinib 60 mg PO 24 hourly
Continue until disease progression or unacceptable toxicity 		Adverse Reactions
  • CNS effects (headache, dizziness); GI effects (dysgeusia, diarrhea, nausea/vomiting, stomatitis, constipation, abdominal pain, dyspepsia); Respiratory effects (dysphonia, dyspnea, cough, pulmonary embolism); Dermatologic effects (alopecia, pruritus, palmar-plantar erythrodysesthesia [PPE] syndrome, rash, dry skin); Musculoskeletal effects (pain in extremity, muscle spasms, arthralgia); Metabolic and endocrine effects (hypophosphatemia, hypoalbuminemia, hypomagnesemia, hyponatremia, hypokalemia, hyperkalemia, hypocalcemia, hyperbilirubinemia); Other effects (anemia, hypothyroidism, decreased appetite, hypertension, proteinuria, fatigue, mucosal inflammation, asthenia)
Special Instructions
  • Should be taken on an empty stomach
  • Avoid use in patients with history of hemorrhage or hemoptysis
  • Use with caution in patients with hypertension, wound healing complications, renal and hepatic impairment
  • Monitor BP, liver function tests (LFTs) and kidney function before therapy and regularly thereafter; monitor platelet count and urine protein regularly; monitor for signs and symptoms of reversible posterior leukoencephalopathy syndrome (RPLS) and for thromboembolic events
Dabrafenib BRAF V600E mutation-positive solid tumors:
150 mg PO 12 hourly in combination with Trametinib
Continue until disease progression or unacceptable disease toxicity 		Adverse Reactions
  • CV effects (cardiomyopathy, decreased left ventricular ejection fraction [LVEF], hypertension); Dermatologic effects (acneiform rash, PPE syndrome, dermatitis); Other effects (granulomatous nephritis, hepatic events, hemorrhage, hyperglycemia, pancreatitis, ocular toxicity, serious febrile reactions, pneumonitis)
Special Instructions
  • Should be taken on an empty stomach
  • Use with caution in patients with pre-existing DM or hyperglycemia, risk factors for arrhythmias, severe renal and moderate to severe hepatic impairment
  • Monitor serum glucose, electrolytes and renal function regularly and LFTs every 4 weeks
Entrectinib NTRK gene fusion-positive:
≥12 years old with BSA 0.91-1.10 m2: 400 mg PO 24 hourly
≥12 years old with BSA 1.11-1.50 m2: 500 mg PO 24 hourly
≥12 years old with BSA >1.50 m2: 600 mg PO 24 hourly
Adult: 600 mg PO 24 hourly
Continue until disease progression or unacceptable disease toxicity 		Adverse Reactions
  • GI effects (constipation, dysgeusia, diarrhea, nausea/vomiting, dysphagia); CNS effects (dizziness, cognitive impairment, fatigue, dysesthesia, headache, peripheral sensory neuropathy, ataxia, syncope); Respiratory effects (dyspnea, cough); Musculoskeletal effects (myalgia, arthralgia, muscular weakness); CV effects (edema, hypotension, CHF, prolonged QT interval); Hematologic effects (neutropenia, anemia); Other effects (increased weight, pyrexia, vision disorders, fractures, dehydration, increased creatinine, increased AST/ALT, lung infection, urinary tract infection [UTI], rash)
Special Instructions
  • Avoid use in patients with congenital QT syndrome or QT interval >450 milliseconds, concomitant use with strong or moderate CYP3A inducers or other agents that prolong QT interval
  • Use with caution in patients with cognitive disorders (eg confusion, mental status changes, memory impairment, hallucinations), mood disorders, dizziness, sleep disturbances, new or worsening CHF, myocarditis, QT prolongation, at risk for fractures, hyperuricemia
  • Withhold treatment for new onset or worsening CHF, new visual changes or changes that interfere with activities of daily living or presence of CNS effects (cognitive impairment, mood disorders, dizziness, sleep disturbances)
  • Assess LVEF, serum uric acid levels prior to initiation of therapy
  • Monitor LFTs every 2 weeks during the first month of treatment, then monthly thereafter, and as clinically indicated
Everolimus 10 mg PO 24 hourly
May be reduced to 5 mg daily if needed 		Adverse Reactions
  • GI effects (dysgeusia, stomatitis, diarrhea, nausea/vomiting, decreased appetite, decreased weight); Respiratory effects (pneumonitis, cough, dyspnea); CNS effects (headache, fatigue, pyrexia, insomnia); Dermatologic effects (pruritus, dry skin, rash, nail disorder); Other effects (infections, epistaxis, mucosal inflammation, peripheral edema)
Special Instructions
  • Avoid use in patients with hypersensitivity to Everolimus and other rapamycin derivatives
  • Avoid use of alcohol- or peroxide-containing mouthwashes or in patients receiving live vaccines
  • Use with caution in patients using CYP3A4 or P-glycoprotein (PgP) inhibitors and inducers, in patients with severe hepatic impairment (Child-Pugh C)
  • Treat pre-existing infections prior to therapy
  • Monitor for non-infectious pneumonitis especially in patients with non-specific respiratory signs and symptoms, hypersensitivity reactions, renal failure events
  • Monitor renal function, fasting serum glucose, lipid profile, and complete blood count (CBC) prior to therapy and periodically thereafter
Larotrectinib NTRK gene fusion-positive:
1 month-18 years old: 100 mg/m2 PO 12 hourly
Max dose: 100 mg/dose
Adult: 100 mg PO 12 hourly
Continue until disease progression or unacceptable disease toxicity 		Adverse Reactions
  • GI effects (nausea/vomiting, constipation, diarrhea); CNS effects (delirium, dysarthria, dizziness, gait disturbance, paresthesia, memory impairment); Other effects (increased LFTs, anemia, fatigue, cough, skeletal fractures)
Special Instructions
  • Swallow capsules whole with water
  • Use with caution in patients with hepatic impairment, women of childbearing potential
  • Monitor baseline LFTs before treatment, monthly for the first 3 months then periodically thereafter; monitor for signs and symptoms of neurotoxicity and skeletal fractures
Lutetium (177Lu) oxodotreotide 7,400 MBq slow IV infusion over approximately 30 ± 10 minutes at
400 mL/hr every 8 weeks for 4 doses 		Adverse Reactions
  • Hematologic effects (thrombocytopenia, anemia, lymphopenia); GI effects (decreased appetite, nausea/vomiting, abdominal pain); CNS effects (dizziness, headache); Other effect (muscle spasm)
Special Instructions
  • Dosage interval may be increased up to 16 weeks if severe toxicity occurs
  • Administer amino acid solution at 250-500 mL/hr 30 minutes prior to infusion for renal protection
  • Premedicate with antiemetics at least 30 minutes prior to start of amino acid solution infusion
  • Avoid in patients with kidney failure with CrCl <30 mL/min, severe heart failure, impaired hematologic function, liver impairment
  • Monitor CBC, liver and kidney function at baseline and during treatment
Pembrolizumab Metastatic MSI-H, dMMR or TMB-H cancer: 200 mg IV infusion over 30 minutes every 3 weeks or 400 mg IV infusion over 30 minutes every 6 weeks
Max duration: 2 years		 Adverse Reactions
  • Immune-mediated reactions (colitis, DM, hepatitis, hypothyroidism or hyperthyroidism, hypophysitis, nephritis, pneumonitis); GI effects (diarrhea, abdominal pain); Dermatologic effects (vitiligo, rash, pruritus); Other effects (pyrexia, arthralgia, back pain, cough, hyponatremia)
Special Instructions
  • Use with caution in patients with autoimmune disorders, recipient of allogeneic hematopoietic stem cell transplant or solid organ transplant
  • Monitor for signs and symptoms of immune-mediated adverse reactions such as pneumonitis, colitis, hepatitis, endocrinopathies, nephritis
  • Continue treatment until disease progression or unacceptable toxicity
    • Withhold use if with moderate grade 2 pneumonitis, grade 2-3 colitis, grade 2 nephritis or hypophysitis, AST/ALT >3 to 5x upper limit normal (ULN) or total bilirubin >1.5 to 3x ULN; discontinue permanently if with grade 3-4 pneumonitis, grade 4 colitis, grade 3-4 nephritis or hypophysitis, AST/ALT >5x ULN or total bilirubin >3x ULN
Repotrectinib NTRK gene fusion-positive solid tumors:
160 mg PO 24 hourly x 14 days then increased to 160 mg PO 12 hourly until disease progression or unacceptable toxicity 		Adverse Reactions
  • GI effects (nausea/vomiting, constipation, dysgeusia, diarrhea, decreased appetite); CV effect (edema); Endocrine/metabolic effects (decreased/increased serum glucose, increased serum potassium and/or sodium, weight gain); Hematologic effects (decreased neutrophils and/or hemoglobin, increased INR, prolonged prothrombin time, lymphocytopenia); Hepatic effects (increased AST, ALT and/or alkaline phosphatase); CNS effects (ataxia, cognitive dysfunction, anemia, aphasia, confusion, delirium, delusion, hallucination, impaired consciousness, dizziness, peripheral neuropathy, drowsiness, hypersomnia, insomnia, fatigue, headache); Respiratory effects (cough, dyspnea, pneumonia); Other effects (visual disturbance, myalgia)
Special Instructions
  • Monitor LFTs and creatine phosphokinase every 2 weeks during the first month of therapy then monthly thereafter and as clinically indicated; monitor serum uric acid before initiation then periodically during treatment
  • Monitor for signs and symptoms of CNS toxicity and new or worsening pulmonary symptoms indicative of interstitial lung disease
Selpercatinib RET gene fusion-positive tumors
<50 kg: 120 mg PO 12 hourly
≥50 kg: 160 mg PO 12 hourly
Continue until disease progression or unacceptable toxicity 		Adverse Reactions
  • CNS effects (headache, dizziness, fatigue); CV effects (prolonged QT interval on ECG, hypertension, edema); Metabolic and endocrine effects (hypothyroidism, decreased serum potassium, sodium, magnesium, calcium and glucose); GI effects (decreased appetite, abdominal pain, diarrhea, nausea/vomiting, constipation, dry mouth); Hepatic effects (increased AST/ALT, bilirubin, alkaline phosphatase); Hematologic effects (hemorrhage, decreased platelet count and lymphocytes); Other effects (pyrexia, rash, pneumonitis, chylothorax, chylous ascites, increased creatinine)
Special Instructions
  • Confirm presence of RET gene fusion before initiation
  • Avoid in patients with uncontrolled hypertension
  • Use with caution in patients with congenital or acquired long QT syndrome or other clinical conditions predisposing to arrhythmias, hepatic impairment
  • Correct hypokalemia, hypomagnesemia and hypocalcemia prior to treatment initiation
  • Permanently discontinue if severe or life-threatening hemorrhage occurs, with recurrent hypersensitivity or medically significant hypertension
  • Monitor the following:
    • BP at baseline, after 1 week of treatment and monthly thereafter
    • ECG and serum electrolytes after 1 week of treatment, monthly for the first 6 months and as clinically indicated
    • TSH at baseline and periodically during treatment
    • LFTs before initiation, every 2 weeks during first 3 months of treatment then monthly thereafter
Streptozocin 1,000 mg/m2 IV injection/infusion over 30 minutes-4 hours weekly for the first 2 weeks
May increase dose up to
1,500 mg/m2
or
500 mg/m2 IV injection/infusion over 30 minutes-4 hours for 5 days every 6 weeks
or
500 mg/m2 IV injection/infusion over 30 minutes-4 hours 24 hourly for 5 days, then 1,000 mg/m2 IV injection/infusion over 30 minutes-4 hours every 3 weeks		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); CNS effects (confusion, lethargy, depression); Metabolic effects (alteration in liver function, diabetogenic effect, hypoglycemia); Local effects (ulceration, necrosis); cumulative nephrotoxicity which may be severe and irreversible
Special Instructions
  • Use with caution in patients with pre-existing renal impairment
  • Monitor CBC, renal and hepatic function routinely during therapy
    • Reduce dose or discontinue treatment if renal toxicity occurs
Sunitinib 37.5 mg PO 24 hourly continuously without a scheduled off-treatment period
May increase or decrease dose in 12.5-mg increments based on individual safety and tolerability
Max dose: 50 mg/day 		Adverse Reactions
  • CNS effects (fatigue, headache, fever); GI effects (diarrhea, nausea/vomiting, mucositis/stomatitis, dyspepsia, abdominal pain, altered taste, constipation); Dermatologic effects (rash, skin discoloration, dry skin, hair color changes); Respiratory effects (cough, dyspnea); Other effects (hypertension, peripheral edema, arthralgia)
Special Instructions
  • Use with caution in patients with LV dysfunction, QT interval prolongation, torsade de pointes, hypertension, hemorrhagic events, thyroid dysfunction, impaired wound healing, adrenal insufficiency
  • Baseline monitoring of LFTs, LVEF, and clinical signs and symptoms of CHF is advised
  • Perform CBC and serum chemistries including phosphate at the beginning of each treatment cycle
Trametinib BRAF V600E mutation-positive solid tumors:
2 mg PO 24 hourly in combination with Dabrafenib
Continue until disease progression or unacceptable disease toxicity 		Adverse Reactions
  • CV effects (heart failure, LV dysfunction, decreased LVEF, hypo-/hypertension, edema); Dermatologic effects (acneiform rash, dermatitis, PPE syndrome, erythema); GI effects (abdominal pain, diarrhea, stomatitis); Other effects (neutropenia, serious febrile reactions, fever, chills, elevated LFTs, hyperglycemia, retinal pigment detachment, pneumonitis)
Special Instructions
  • Should be taken on an empty stomach
  • Avoid use in patients with history of retinal vein occlusion
  • Use with caution in patients with impaired LVEF, DM or hyperglycemia, hypertension, risk factors for GI perforation, moderate to severe hepatic and severe renal impairment
  • Monitor LFTs, BP, CBC, metabolic panel, serum albumin at baseline and periodically thereafter; assess LVEF at baseline, 1 month after initiation then at intervals of 2-3 months

Trophic Hormones & Related Synthetic Drugs

Drug Dosage Remarks
Lanreotide 60-120 mg deep SC injection every 28 days Adverse Reactions
  • GI effects (diarrhea or soft stools, abdominal pain, flatulence, anorexia, nausea/vomiting); Other effects (moderate transitory pain or local redness at injection site, disorders of glucose regulation, occurrence of gallstone in long-term treatment)
Special Instructions
  • Use with caution in patients with hepatic or renal failure
  • Eliminate the presence of obstructive intestinal tumor in carcinoid syndromes prior to therapy
  • Monitor blood glucose level especially in patients with DM
  • In prolonged treatment, perform an ultrasound of gallbladder before treatment and every 6 months
  • Continue treatment until disease progression or unacceptable toxicity
Octreotide 50-100 mcg SC 12-24 hourly
May increase to 100-200 mcg 8 hourly depending on tolerability and therapeutic effect
Long-acting release (LAR)
Patients adequately controlled with SC Octreotide
Initial dose: 20 mg deep intragluteal injection at 4-week intervals x 3 months
Dose may be increased to 30-40 mg or decreased to 10 mg after 3 months depending on response
Patients not previously treated with SC Octreotide
Initial dose: 0.1 mg SC Octreotide 8 hourly for 2 weeks to assess response and tolerability prior to initiating treatment with Octreotide LAR
After 3 months of treatment, Octreotide LAR dose may be reduced to 10 mg or increased to 30 mg every 4 weeks
Advanced NETs of midgut or unknown primary tumor location:
30 mg deep intragluteally every 4 weeks until disease progression 		Adverse Reactions
  • GI effects (diarrhea, abdominal pain, nausea/vomiting, constipation, flatulence, dyspepsia, abdominal bloating, steatorrhea, loose stools, discoloration of feces); CNS effects (headache, dizziness); Metabolic and endocrine effects (hyperglycemia or hypoglycemia, hypothyroidism, thyroid dysfunction, elevated transaminase levels); Dermatologic effects (pruritus, rash, alopecia); Other effects (local injection site reactions, cholelithiasis, dyspnea, bradycardia)
Special Instructions
  • Patients on SC Octreotide should continue treatment with previously effective dosage for 2 weeks after the first injection of Octreotide LAR
  • Use with caution in patients with type I DM, insulinomas, history of vitamin B12 deprivation
  • Monitor thyroid function on prolonged use and glucose tolerance
  • Periodic gallbladder exam is recommended

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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