Key points:

• The classification of neuroendocrine tumors based on grade, histological features, and the significance of KI-67.
• The role of imaging modalities, including Gallium PET-CT and its importance in evaluating disease extent.
• Treatment strategies for localized versus metastatic NETs, including the use of somatostatin analogs and the nuances of observation versus intervention.
• Insights into the latest treatment options, including lutetium dotatate, Capecitabine-Temozolomide, and the anticipated approval of Cabozantinib.
• The potential role of NGS testing and the challenges of combining chemotherapy with immunotherapy in high-grade neuroendocrine tumors.
In this episode of the Oncology Brothers podcast, we had the privilege of speaking with Dr. Pamela Kunz, a world-renowned medical oncologist from the Yale Cancer Center, about neuroendocrine tumors (NETs). We began by discussing the complexities of NET classification, including the importance of tumor grade, histological features, and the role of the KI-67 index in determining treatment strategies.
Dr. Kunz emphasized the significance of understanding the primary site of the tumor, whether it be the pancreas, small intestine, or lung, and how this influences treatment decisions. We explored the use of imaging techniques, particularly Gallium Dotatate PET-CT scans, and how they complement traditional cross-sectional imaging in evaluating disease extent.
As we delved into treatment options, Dr. Kunz highlighted the importance of tailoring therapy based on disease extent, symptoms, and tumor grade. For localized disease, surgery is often the first line of treatment, while metastatic cases may require a more nuanced approach, including observation for asymptomatic patients or the use of somatostatin analogs for symptom control.
We also discussed the role of somatostatin analogs, such as octreotide and lanreotide, in managing both functional and non-functional NETs, and the considerations for their use in treatment. Dr. Kunz provided insights into the sequencing of therapies for high-grade NETs, including the potential use of lutetium dotatate and the ongoing clinical trials that may shape future treatment paradigms.
Finally, we touched on the emerging role of next-generation sequencing (NGS) in identifying actionable mutations, particularly in poorly differentiated neuroendocrine carcinomas, and the potential for combining chemotherapy with immunotherapy in high-grade cases.
Overall, this episode provided a comprehensive overview of the current landscape of neuroendocrine tumors, emphasizing the importance of individualized treatment strategies and the exciting developments on the horizon in this field. We look forward to sharing more insights and updates in future episodes. Thank you for joining us!