Cabozantinib in Grade 3 Neuroendocrine Tumors

The panel focuses on the use of cabozantinib in grade 3 neuroendocrine tumors, a population increasingly encountered in clinical practice, possibly reflecting more standardized Ki-67 testing across community settings. Faculty describe adjusting management for higher-grade disease by leaning away from somatostatin analog approaches, intensifying scan schedules, and monitoring patients more closely. They emphasize the historical scarcity of data in grade 3 disease, making the CABINET grade 3 substudy of 24 patients particularly valuable. In this subgroup, cabozantinib demonstrated meaningful benefit, with progression-free survival of roughly 7.9 months versus 3 months in the placebo arm and a striking hazard ratio. Faculty find this reassuring evidence to share with patients and to support use in a setting where most other agents lack data outside radioligand therapy. The discussion praises the trial's inclusive design for incorporating grade 3 patients and positions it as a model for future neuroendocrine trial development.