Neuroendocrine tumors (NETs) were previously thought be rare diseases where publications were frequently based on anecdotes, retrospective series, and small single arm studies. Prospective controlled clinical trials were rarely pursued leading to slow progress. Prior to 2011, streptozocin was the only FDA approved therapy for oncologic control and this limited to pancreatic NETs with many questioning its utility. Pivoting the field toward to one that is evidence-based and where rigorous controlled clinical trials are the norm have led to an explosion of new studies and treatment options. The completion of eight randomized controlled phase III studies have resulted in five FDA and six EMA approvals over the past seven years for oncologic control of NETs. Three placebo controlled phase III studies targeting carcinoid syndrome have resulted in two FDA approvals. While it has been difficult to demonstrate overall survival benefits in individual studies due to the number of patients needed, research using population based registries have shown improving overall survival especially among patients with advanced metastatic disease.