Modern Approaches to Treating Neuroendocrine Tumors

Eileen M. O’Reilly, MD, Winthrop Rockefeller Endowed chair in Medical Oncology, co-director, Medical Initiatives, David M. Rubenstein Center for Pancreatic Cancer Research, and section head, Hepatopancreaticobilary & Neuroendocrine Cancers at Memorial Sloan Kettering Cancer Center, discusses the current treatment landscape for neuroendocrine tumors.

How oncologists approach the treatment of neuroendocrine tumors is largely dependent on tumor grade and the pattern of disease, according to O’Reilly. It is important to determine these considerations before selecting a treatment option.

Transcript

0:08 | So, in terms of neuroendocrine cancers, there are a number of approaches depending on the type of disease in terms of the differentiation and grade of the tumor and depending on the pattern of disease. So, typical considerations would be looking to know whether a tumor has some at a certain receptor positivity, and that in the past was evaluated by using an octreotide scan now galleon dotatate PET is the main tool for the well-differentiated, asymptomatic setting of growing disease with a neuroendocrine cancer using a long-acting somatostatin analog would be a choice.

0:56 | Then, for pancreatic neuroendocrine cancers, those that whose disease grows on somatostatin targeting agents, or has a more intermediate grade biology considerations might include a VEGF tyrosine kinase inhibitor such as sunitinib [Sutent] or an mTOR targeted agents such as everolimus or using a peptide receptor radionuclide therapy but is also a choice and for well differentiated to intermediate grade neuroendocrine cancers. We also use capecitabine and temozolomide [Temodar] so chemotherapy can have a role and if an individual has regional disease, so for example, liver confined disease, hepatic artery embolization or occasionally why 90 less commonly, but in very selected patients, surgical debulking. So, there's a wide choice of approaches depending on again, the biology, disease trajectory, pattern of disease in terms of neuroendocrine cancers.