What systemic therapy would you offer for a local, unresectable relapse of a mixed acinar neuroendocrine carcinoma of the pancreas?

This is a very interesting question. I agree with the overall discussion with some points that need to be clear:

• Did the pathology show mixed acinar and NEC with >30% of each component? or just acinar with NE features? I agree the data about MANEC is very limited and exclusively retrospective.
• What ...

MANEC's are a unique and extremely rare entity and hence, guidelines regarding management are limited. Their prognosis is poor due to aggressive tumor biology.

Management can be extrapolated from high-grade neuroendocrine carcinoma of the GI tract and pancreatic adenocarcinoma in the management of t...