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ESMO 2025 | ASPEN: active surveillance vs surgery for small nonfunctioning PanNETs
Stefano Partelli, MD, Vita-Salute San Raffaele University. Milan, Italy, discusses the ASPEN study (NCT03084770), the largest prospective international cohort assessing management of asymptomatic, sporadic nonfunctioning pancreatic neuroendocrine tumors (PanNETs). Most patients were managed with surveillance and showed comparable overall survival to those who underwent surgery. Relevant tumor growth occurred infrequently, and distant metastases were rare, supporting active surveillance as a safe and effective approach for most patients. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
The ASPEN study is a prospective international multicentric observational study and the aim of the study was to explore the best management of small asymptomatic non-functioning pancreas NETs. It started in 2017 and it ended in 2024 and it enrolled 1,000 patients. The main finding was that the majority of these patients were actually followed up, so they underwent active surveillance, and a small part of these patients underwent upfront surgery...
The ASPEN study is a prospective international multicentric observational study and the aim of the study was to explore the best management of small asymptomatic non-functioning pancreas NETs. It started in 2017 and it ended in 2024 and it enrolled 1,000 patients. The main finding was that the majority of these patients were actually followed up, so they underwent active surveillance, and a small part of these patients underwent upfront surgery. So probably the most important finding was that for more than 860 patients who underwent active surveillance, we had very good results. Only three patients developed liver metastasis and the other patients, some of these patients had an increasing tumor and they eventually underwent surgery. So summarizing the result of the study we can say that the number needed to treat in order to possibly prevent the metastasis is almost 300 and the number needed to harm considering the risk that pancreatic surgery carries is six so we can conclude that routine surgery for a small pancreatic net is not necessary except for very very selective cases.
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