Hagen F. Kennecke, MD, MHA, FRCPC, discusses the treatments available for patients with advanced gastroenteropancreatic neuroendocrine tumors.
Hagen F. Kennecke, MD, MHA, FRCPC, a medical oncologist at Virginia Mason Medical Center, discusses the treatments available for patients with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
When patients have advanced disease, they should always consider surgery first and then get staged with Gallium-68 dotatate (Netspot) PET/CT scans, explains Kennecke. If surgery is not possible, patients receive liver-directed therapy followed by targeted treatment, such as Lutetium-177-PSMA-617 plus chemotherapy or targeted therapy with everolimus (Afinitor), says Kennecke.
Sequencing, according to Kennecke, is less important compared with how urgently patients need therapy and how they react to treatment. If patients require debulking surgery, then surgery, liver-directed therapy, or chemotherapy will be most effective. When a patient has more indolent disease that is positive for receptors, they may be eligible for targeted and radiopeptide therapies, concludes Kennecke.