Targeted drugs work differently from standard chemotherapy (chemo) drugs. These drugs target specific parts of cancer cells. They are sometimes helpful when chemo is not, and they often have different side effects than chemo.
The targeted drugs used to treat pancreatic neuroendocrine tumors (NETs) work by blocking angiogenesis (the growth of new blood vessels that nourish cancers) or important proteins (called tyrosine kinases) in cancer cells that help them grow and survive.
Sunitinib blocks several tyrosine kinases and attacks new blood vessel growth. It has been shown to help slow tumor growth. This drug is taken as a pill once a day.
The most common side effects are nausea, diarrhea, changes in skin or hair color, mouth sores, weakness, and low blood cell counts. Other possible effects include tiredness, high blood pressure, heart problems, bleeding, hand-foot syndrome (redness, pain, and skin peeling of the palms of the hands and the soles of the feet), and low thyroid hormone levels.
Everolimus blocks a protein known as mTOR, which normally helps cells grow and divide. It has been shown to help treat advanced pancreatic NETs. Everolimus is a pill taken once a day.
Common side effects of this drug include mouth sores, infections, nausea, loss of appetite, diarrhea, skin rash, feeling tired or weak, fluid buildup (usually in the legs), and increases in blood sugar and cholesterol levels. A less common but serious side effect is damage to the lungs, which can cause shortness of breath or other problems.
Belzutifan is a type of drug known as a HIF inhibitor. It blocks a protein called hypoxia-inducible factor 2 alpha (HIF-2a), which is involved in both cancer cell growth and the formation of new blood vessels in tumors. This drug is taken as pills, typically once a day.
Belzutifan can be used in people with von Hippel-Lindau (VHL) disease who have a pancreatic NET and don’t need surgery right away.
Common side effects of this drug include low red blood cell counts (anemia), feeling tired and/or dizzy, nausea, headache, increased blood sugar levels, and changes in lab tests showing the drug might be affecting the kidneys. Less common but more serious side effects can include very low red blood cell counts (severe anemia), which might require blood transfusions, and low oxygen levels in the body, for which you might need oxygen therapy or even be admitted to the hospital.
To learn more about how targeted drugs are used to treat cancer, see Targeted Cancer Therapy.
To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Chan JA, Kulke M, Clancy TE. Metastatic well-differentiated pancreatic neuroendocrine tumors: Systemic therapy options to control tumor growth and symptoms of hormone hypersecretion. UpToDate website. https://www.uptodate.com/contents/metastatic-well-differentiated-pancreatic-neuroendocrine-tumors-systemic-therapy-options-to-control-tumor-growth-and-symptoms-of-hormone-hypersecretion Updated August 31, 2018. Accessed October 9, 2018.
National Cancer Institute. Physician Data Query (PDQ). Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment – Patient Version. 2018. Accessed at https://www.cancer.gov/types/pancreatic/patient/pnet-treatment-pdq on October 9, 2018.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. V.3.2018. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf on October 5, 2018.
Pasricha G, Padhi P, Daboul N, Monga DK. Management of Well-differentiated Gastroenteropancreatic Neuroendocrine Tumors (GEPNETs): A Review. Clin Ther. 2017 Nov;39(11):2146-2157. doi: 10.1016/j.clinthera.2017.10.010.
Raymond E, Dahan L, Raoul JL, et al. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med. 2011;364:501−513.
Schneider DF, Mazeh H, Lubner SJ, Jaume JC, Chen H. Chapter 71: Cancer of the endocrine system. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier: 2014.
Yao JC, Evans DB. Chapter 85: Pancreatic neuroendocrine tumors. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
Yao JC, Shah MH, Ito T, et al. Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med. 2011;364:514−523.
Last Revised: August 17, 2021
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
