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Following Encouraging Therapeutic Advances, Focus in NETs Turns to Sequencing

Caroline Seymour
Published: Tuesday, Mar 05, 2019

Ana Maria Cristina De Jesus-Acosta, MD

Ana Maria Cristina De Jesus-Acosta, MD

Despite the activity of peptide receptor radionucleotide therapy (PRRT), somatostatin analogs remain the recommended frontline treatment for patients with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs), after which sequencing becomes less clear, explained Ana Maria Cristina De Jesus-Acosta, MD.

 State of the Science Summit™ on Gastrointestinal Cancers, De Jesus-Acosta, assistant professor of oncology at Johns Hopkins Medicine, discussed somatostatin analogs and PRRT, and spoke to the discussion regarding the optimal sequence of therapy in patients with NETs. 

OncLive®: Could you discuss the key data with somatostatin analogs?

De Jesus-Acosta: The data are based on the CLARINET study. Somatostatin analogs have been used for decades to control the symptoms of hormone secretion in patients with NETs. By 2009, the PROMID study was published, which demonstrated an antiproliferative effect by controlling PFS in patients with NETs. Subsequently, the phase III CLARINET clinical trial with lanreotide showed improved PFS compared with placebo. That is a huge advance because we want to be able to control disease burden and delay progression, so we can delay their symptoms.

Are somatostatin analogs used in patients with all types of NETs?

They are used for all types of NETs when patients have functional symptoms of carcinoid syndrome such as flushing and diarrhea. Based on the PROMID and CLARINET studies these agents can be used to control their time to progression. They’re usually the first-line therapy that is provided to patients.  

Could you discuss the data that led to the approval of Lutathera?

The NETTER-1 trial was the first prospective phase III clinical trial that evaluated PRRT in patients with GEP-NETs. In that study, patients were randomized to receive PRRT in combination with best supportive care—which was octreotide—versus higher-dose octreotide injections. The patients who were treated with PRRT received 4 infusions.
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TitleExpiration DateCME Credits
Oncology Briefings™: Individualizing Treatment After Second-Line Therapy for Patients With mCRCAug 29, 20191.0
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