Evolving Understanding and Treatment Landscape

Faculty discuss how the understanding and management of neuroendocrine tumors has transformed over the past two decades. The panel notes rising incidence and prevalence driven both by increased imaging and a true increase in disease, alongside improved recognition of tumor heterogeneity. Speakers describe the shift away from clumping all tumors as indolent carcinoid disease toward more nuanced grading and differentiation, with several advocating finer stratification within grades based on Ki-67. The conversation addresses the evolving classification of grade 3 disease and the importance of distinguishing well-differentiated grade 3 neuroendocrine tumors from poorly differentiated carcinomas, given divergent treatment implications. Faculty place current practice in historical context, recalling when surgery and somatostatin analogs were the only options, and highlight the subsequent approval of systemic therapies, radioligand therapy, and refined liver-directed approaches. They also welcome trials comparing two active agents and improving preclinical models for this expanding treatment landscape.