There has been one fully published Phase III study evaluating everolimus in the treatment of advanced pNET – this showed that, compared with placebo, it increased the median PFS by around 6 months.  The findings suggest that one out of every eight patients will discontinue everolimus treatment due to toxicity, rather than disease-progression.  No head to head comparisons of everolimus with other agents in this setting are available.  As 73% of patients randomised to placebo in the study crossed over to everolimus following disease progression, the final analysis of overall survival (to occur after approximately 250 events have occurred) will be compromised.  Median overall survival had not been reached at the time of the reported analysis (median follow-up of 17 months), and it remains to be seen whether the improvement in PFS will translate into improved overall survival.