Treatment Selection in First Line and After Progression

Faculty emphasize that surgery remains the only curative option for localized tumors, with many lung and small bowel cases identified incidentally and managed by resection followed by surveillance. For advanced disease, somatostatin analogs are the predominant first-line choice, providing both tumor control and management of hormonal syndromes. The discussion details the factors guiding initiation, including symptom burden, documented disease stability, tumor grade, and primary site. Faculty then turn to treatment selection after progression, noting that the generally well-tolerated options make disease factors more decisive than patient factors. Site of disease, extent of metastatic burden, and differentiation status shape choices among everolimus, cabozantinib, capecitabine plus temozolomide, and radioligand therapy. The panel also highlights liver-directed and surgical approaches as important considerations even in metastatic disease.