Potential Imaging and Molecular Predictors of Response to Novel Therapies in Metastatic Pancreatic Neuroendocrine Tumors

• Overall survival [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  standard MRI sequences will be performed, according to guidelines from RECIST 1.1.
• best response [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  standard MRI sequences will be performed, according to guidelines from RECIST 1.1.

Sunitinib and everolimus are two new treatments approved in 2011 for patients with pancreatic neuroendocrine tumor (pNET). Since the patient is eligible for treatment with either sunitinib or everolimus, it can help us identify factors that may help future patients benefit from these two therapies.

The investigators routinely monitor the progress of the treatment with magnetic resonance imaging (MRI) scans to measure how pNET tumors change in size over time. MRI can also measure how water moves within tumors, which is another way to measure how tumors respond to treatment. In this study, the investigators will look at the MRI characteristics of tumors in the liver as the patient undergoes treatment, to help us identify changes on MRI that may best predict a benefit to sunitinib or everolimus treatment.

Potential research patients will be identified by doctors from the Gastrointestinal Oncology Service in the Department of Medicine.

Inclusion Criteria:

• Histopathologic evidence of well differentiated pancreatic neuroendocrine tumor
• Evidence of metastatic disease of at least 2.0 cm in the liver by prior MRI or CT imaging. Both patients with synchronous disease and those with prior resected primary cancers will be eligible.
• Patient ≥18 years of age on the day of signing informed consent.
• Planned initiation of active therapy with either everolimus or sunitinib. Patients can be included in this study, regardless of prior therapy, but cannot undergo concurrent therapy, such as hepatic artery embolization
• Available archival tissue with adequate FFPE tissue for analysis verified by a pathologist (in cases of biopsies less than 2 cm and/or less than 70% tumor content 10 slides will be required for adequate DNA preparation. For larger biopsies and any resections, 5 slides are sufficient for DNA extraction).

Exclusion Criteria:

• Any contraindication to MRI based on departmental MR questionnaire
• Inability to cooperate for an MR exam
• Patient has a history of a second active malignancy with evidence of metastases. Patients with a history of resected prior malignancy or one that would not interfere with the MRI results are allowed.
• Patient has known psychiatric or substance abuse disorders that would, in the opinion of the treating investigator, interfere with cooperation with the requirements of the trial.