Dr Scott Paulson on Standard of Treatment, Novel Approaches Being Taken in GEP-NETs

Scott Paulson, MD, co-director of the Gastrointestinal Research Program for The US Oncology Network, medical director for the Neuroendocrine Research and Treatment Center at Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, explains the current standard of treatment and novel approaches being taken in gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

Transcript

What is the current standard of treatment for locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors?

Gastroenteropancreatic neuroendocrine tumors, or GEP-NETs, it’s a pretty heterogeneous bunch. I’d still say the standard of care is if you can try cut them out, cut them out, and otherwise, somatostatin analogs are going to be the standard frontline treatment for most low-grade, well-differentiated neuroendocrine tumors. I think there’s still quite a bit of confusion in the community because a lot of different agents have been pouring in, but at the heart of it it’s somatostatin analogs and a good multidisciplinary discussion with surgeons and interventional radiologists is going to be your first approach.

Are there currently any novel approaches being taken?

With novel approaches, I’d say the most novel approach is peptide receptor radionuclide therapy (PRRT), and there’s been a lot of buzz this meeting about PRRT, and kind of its other terms, liquid radiation, radioactive octreotide, and I think this is probably the most exciting thing that’s currently happening in the United States. It’s been used in Europe for a long period of time. So, whether you really want to call it a novel approach is kind of a matter of semantics. The FDA is calling it new, and now that it’s on American soil, we’re looking at it as fairly new.

There’s a lot of different targeted therapies that are in development. When it comes to GEP-NETs, the pancreas has a whole longer list of therapies that can be used, including everolimus, sunitinib. Capecitabine and temozolomide recently demonstrated some pretty significant data that’s kind of added to the compendium in pancreatic NETs. Whereas with nonpancreatic GEP-NETs, you’re standard of therapy is still going to be somatostatin analogs, everolimus, and now the introduction of PRRT.