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Conclusion: Effective Sequencing of Treatments for pNETs

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The COOPERATIVE-2 study is a randomized, open-label phase II multicenter study evaluating the efficacy of everolimus alone or in combination with pasireotide LAR for patients with advanced progressive pancreatic neuroendocrine tumors (pNETs), Rodney F. Pommier, MD, notes. One concern with pasireotide is that it may cause more hyperglycemia in patients compared with octreotide, which can be an issue in patients who had primary pancreatic resections.

This is currently a very exciting time to be treating patients with pNETs, believes Diane Reidy-Lagunes, MD, MS. In many cases, single-agent therapy is just as good as combination therapy, making a design like the COOPERATIVE-2 trial intriguing. In patients with greater tumor burden, combination therapy makes the most sense, Reidy-Lagunes believes.

Jonathan R. Strosberg, MD, believes that with the many new drugs and treatment options that it will take time to learn how to best sequence each therapy. Pommier believes that it is important to consider whether a patient may be a surgical candidate prior to initiating therapy and also once the patient has been on a systemic therapy, because these patients can become surgical candidates. Additionally, Pommier notes, there is more to learn regarding drug sequencing, since the majority of patients with pNETs could benefit from the newer treatments.

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