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Several treatment options are now available for patients with neuroendocrine tumors (NETs), including two new targeted therapies that have been approved for pancreatic NETs. These agents, everolimus and sunitinib, were approved based on an improvement in progression-free survival (PFS), James C. Yao, MD, explains.
Determining the optimal therapy to administer remains a question that should be individualized. Yao recommends administering the targeted agents before chemotherapy for patients with moderate disease volume. However, Yao notes, for patients with heavy tumor volume, it may be necessary to administer chemotherapy upfront.
The optimal targeted agent to administer can be personalized based on comorbidities, Yao describes. Patients with lung disease, COPD, or uncontrolled diabetes should not receive everolimus. Additionally, Yao notes, someone with cardiovascular disease or hypertension should not receive the VEGF inhibitor sunitinib. Outside of this approach for determining treatment, the optimal sequence for these agents has yet to be discovered, Pamela L. Kunz, MD, notes.
In general, the targeted agents approved for pancreatic NETs have led to real benefits for patients. As an example, Yao and Rodney F. Pommier, MD, describe the level of response experienced with everolimus in the RADIANT trials. In both examples, patients receiving everolimus remained on treatment for five or more years with stable disease.