Patient with NETS Post PRRT in Second-Line

NET specialists collaboratively address management for a young pancreatic NET patient with liver metastases, new ascites, and evidence of disease progression and grade migration. Recognizing confirmed extra-hepatic involvement, Dr. Hendirfar highlights the possible origin of ascites and hepatic dysfunction, but ultimately recommends cabozantinib, citing strong response rates and cytoreductive efficacy from the CABINET trial—ideal for patients concerned about marrow toxicity. Dr. Chauhan stresses caution with Ki-67 interpretation on cytology, and the increased risk of myeloid neoplasms when combining alkylators and PRRT. He supports cabozantinib’s marrow-sparing advantage and high response rates for pretreated pancreatic NETs. Dr. Arshad concurs, emphasizing cabozantinib’s quality of life benefits and evidence-backing. Dr. Shaheen notes its superior activity in heavily pretreated populations and supports dose titration. They discuss monitoring disease evolution via DOTA scanning to assess SSTR expression. The panel agrees on cabozantinib’s merit in this scenario, underscoring individualized and data-driven care for refractory pancreatic NETs.