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The clinical benefits of targeted therapies in neuroendocrine tumors (NETs) have primarily been restricted to the pancreatic type. However, clinical trials are currently under way examining the mTOR inhibitor everolimus in a broader patient population.
The RADIANT-2 trial examined everolimus plus octreotide compared to octreotide and placebo as a treatment for patients with carcinoid tumors, James C. Yao, MD, explains. The hazard ratio for progression-free survival in this trial was 0.77 in favor of treatment with everolimus; however, this benefit was not statistically significant. To further cull out the benefits of everolimus in this population, the RADIANT-4 trial will examine everolimus plus best supportive care compared to supportive care and placebo.
Overall, the efficacy of targeted agents in NETs varies by location with a clear divide appearing between pancreatic NETs and carcinoids. Furthermore, Yao notes, as research continues, a subclassification within carcinoid types may become more apparent. The further subdivision of NETs will be shaped by ongoing trials, Yao believes.
Two important phase III trials in this space, Yao notes, have finished accrual and will help shape further understanding of subclasses. The CLARINET study, Yao notes, is examining lanreotide versus placebo in non-functioning enteropancraetic NETs. Additionally, the SWOG 0518 study is looking at octreotide with interferon alfa-2b compared to octreotide and bevacizumab for advanced, high-risk, NETs.