Dr. Kunz on Treatment Options for Pancreatic NETs

Pamela L. Kunz, MD, assistant professor of medicine, Oncology, Stanford University Medical Center, discusses current and future treatment options for patients with neuroendocrine tumors (NETs).

Recently, new biologic agents for pancreatic NETs have been approved, Kunz says. Sunitinib, a VEGF-targeted TKI, and everolimus, an oral mTOR inhibitor, were approved separately for pancreatic NETs based on improvements to progression-free survival. However, Kunz says the data did not show much benefit regarding response rate or tumor shrinkage.

Kunz says when using cytotoxic chemotherapy, such as capecitabine and temozolomide, there tends to be more tumor shrinkage. One of the only approved cytotoxic chemotherapies for pancreatic NETs is streptozotocin. This agent was approved in the 1980s but is toxic and is not used much in current practice. Kunz says temozolomide has a much better safety profile and is currently approved for use in glioblastomas. Temozolomide has been studied in small retrospective studies for small NETs and has shown benefit to response rates.

Data from an interim analysis of a phase II study presented at the 2014 Gastrointestinal Cancer Symposium suggest that patients with carcinoid and pituitary NETs, who have been traditionally chemo-resistant, may obtain “extraordinary responses” with capecitabine and temozolomide (CAPTEM).