Initial Case Assessment and Defining Goals of Care in Progressive Pancreatic Neuroendocrine Tumor

In this opening segment, Dr Shaheen introduces the case of a 54 year old woman with a well differentiated, SSTR positive, grade two pancreatic neuroendocrine tumor and outlines her initial impressions of the patient’s current disease status. She emphasizes that the case reflects a common but challenging scenario in pancreatic NETs, where disease behavior appears relatively indolent over several years yet demonstrates clear and undeniable progression.

Dr Shaheen explains that the four year disease course shapes her goals of care in a nuanced way. While the pace of progression is not aggressive, it is consistent, signaling that continued observation alone is unlikely to be sufficient. As a result, treatment goals must balance durable tumor control with preservation of quality of life, rather than focusing on rapid cytoreduction or short term response.

She highlights several clinical features that strongly influence her thinking about next line strategy. The tumor remains well differentiated with a Ki 67 index of five percent, supporting a biologically intermediate disease state rather than high grade transformation. SSTR positivity confirms that the tumor has followed a classic pancreatic NET trajectory, while prior benefit from somatostatin analogs and PRRT suggests ongoing sensitivity to systemic therapy.

Patient level factors are equally important. An ECOG performance status of one, maintained physical activity, and manageable symptom burden all indicate that the patient is well positioned to tolerate additional therapy. Dr Shaheen stresses that these features allow for thoughtful sequencing rather than reactive decision making.

Overall, this segment sets the clinical foundation for the discussion. Dr Shaheen frames the case as one requiring deliberate goal setting that accounts for disease biology, prior treatment response, and the patient’s desire to maintain an active and meaningful daily life.