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Expert Discusses Recent Progress in NET Management

Allie Strickler @Alliejayes
Published: Monday, Dec 19, 2016
Jonathan R. Strosberg, MD

Jonathan R. Strosberg, MD

Significant progress has been made in recent years in understanding the biology and treatment of neuroendocrine tumors (NETs). The latest research indicates that NETs should not be approached and treated as a single disease. Extensive biological differences based on histology, primary site of the tumor, and numerous other factors have been shown to influence prognosis and response to treatment. Thus, these details must be considered when designing clinical trials and developing novel therapies.

, Jonathan R. Strosberg, MD, associate professor at the H. Lee Moffitt Cancer Center in Florida, discussed his presentation on NETs at the recent 2016 Chemotherapy Foundation Symposium, and shed light on the progress that has been made in this treatment landscape.

OncLive: Please highlight some of the main points from your presentation.

Strosberg: The question I was asked to address is whether we’re making progress in the management of NETs, and I think the answer is unequivocally yes. Prior to 2009, there were no positive published phase III trials.

Since then, there have been 8 trials, 7 of which have reached their primary endpoints. So it’s been a decade of significant improvement. And even though none of these studies were powered to look at overall survival [OS] as an endpoint, we’re certainly seeing evidence of improvement in outcomes.

What are some of the pivotal agents that you feel have impacted the paradigm in the past several years?

The first group is the somatostatin analogs. We use them to control hormonal symptoms like carcinoid syndrome, but with the CLARINET study, we now know that they substantially inhibit tumor growth.

The next important category of treatment is radiolabeled somatostatin analogs, otherwise known as peptide receptor radiotherapy. The one that’s been tested in a phase III trial is lutetium dotatate, also known as Lutathera. It was tested in patients with progressive midgut NETs and showed a very substantial 79% improvement in progression-free survival, and a very strong trend toward improvement in OS, which we hope will be confirmed upon final analysis.

Are we getting better at diagnosing and managing the treatment of NETs?

Certainly. I think pathologists are better at making the diagnosis of a NET, rather than just calling a cancer pancreatic cancer or colorectal cancer. They’re recognizing the neuroendocrine aspects of the disease, and doing the appropriate immunohistochemical staining.
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