How do you decide what to use for 2nd line treatment of liver-predominant metastatic neuroendocrine tumor that has progressed on a somatostatin analog?

Following progression on an SSA, there are a number of options and they differ depending on primary site and whether or not the tumor is functional (ie. secreting a hormone that causes symtoms of hormone excess. I will outline some scenarios below:

1) For patients with non-functional liver-predominant pancreatic NETS, options include everolimus (based on RADIANT 3, Yao N Engl J Med 2011;364:514-23) and sunitinib (Raymond, N Engl J Med 2011;364:501-13). Choice of everolimus vs. sunitinib should depend on patient co-morbidities. Liver directed therapies are also an option and include bland embolization, chemoembolization and radioembolization. Also, cytotoxic chemotherapy, such as temozolomide and capecitabine, can be considered partocularly f...