NANETS Chair Explains How Symposium Addresses the Multidisciplinary Needs of Treating NETs

David Metz, MD

According to David Metz, MD, chair of the North American Neuroendocrine Tumor Society (NANETS), treatment of patients with neuroendocrine tumors (NETs) necessitates a very multidisciplinary approach across many disciplines. Bringing these disciplines together in one place to learn more about neuroendocrine diseases is the specialty of the NANETS Annual Symposium.

The symposium, taking place this Thursday through Saturday in Philadelphia, Pennsylvania, is celebrating its tenth year with an increased focus on young investigators as well as incorporating other specialties, such as interventional radiology, nuclear medicine, surgery, gastroenterology, and more.

Few physicians, says Metz, associate chief for clinical affairs, Gastrointestinal (GI) Division; co-director of the Esophagology and Swallowing Program, and the Neuroendocrine Tumor Center, University of Pennsylvania School of Medicine, primarily focus on NETs, and so it’s important to teach others and spread awareness of the disease process.

In an interview withTargeted Oncology, Metz addressed the role of the 10th Annual NANETS Symposium in addressing the multidisciplinary needs of treating patients with NETs, and exciting aspects of the conference that he is looking forward to.

TARGETED ONCOLOGY:What is the role and purpose of the NANETS Annual Symposium?

Metz:This is a professional organization and its multidisciplinary. We need to stress the fact that to care for patients with NETs, you’ve got to cross all the usual disciplines: medical, surgery, enterology, gastroenterology, etc. The truth is that we have a very varied group of professionals who have shown an interest in this subspecialty beyond just NET specialists—gastroenterologists, like myself, surgical oncologists, interventional radiologists, geneticists, etc. The big problem in terms of patient management is having a broad expertise across disciplines, and finding a way to have people develop an interest across disciplines because NETs are a lot more common than people think. The challenges here are to establish appropriate care at institutions across multiple disciplines and educate people who are interested in this field that there’s more to it than just what you specifically are doing—we really need to have a way to cover the whole basis.

This conference is specifically by professionals for professionals. Our annual meeting, which starts tomorrow, is our all-encompassing, cutting-edge, state-of-the-art education symposium. We also have regional meetings, which are general education meetings set up in local hospitals where people want to develop their expertise in neuroendocrinology.

We’ve divided the annual meeting into a number of sections. There’s going to be a section for early investigators to try to get the young faculty interested in developing careers, and, for example, I’m giving a talk during this session on how to set up a multidisciplinary program.

We then have nurse allied sessions for nurse practitioners, physician assistants, etc.—for all the true faces of the program that look after the patients. The patients get to know the nurse navigators better than anyone else because getting through the system is so difficult and it’s such a complicated disease that there’s so much going on that you need an advocate.

Then we have our research session, which is important in terms of marking the future of this program. We have a number of cutting-edge abstracts that are going to be presented, and clinical and translational work.

Then we have an educational component where we are teaching the interventional radiologist about GI, or the GI physician about endocrinology, or the endocrinology physician about oncology. So, there are many, many levels to this very complicated meeting that’s been structured by our conference organizing committee to try to cover all of the bases and educate. And we have partnered with a number of pharmacy organizers and more, who helped sponsor various aspects so that we can do this, most notably being our grants process, we want to create researchers of the future, and, as you know, NIH [National Institutes of Health] funding is going away so we have 2 grants that we’re awarding this year for basic science and translational research, and for early investigators, and those are some of our proudest achievements here.

TARGETED ONCOLOGY:How do you believe the society and the symposium have changed over the years?

Metz:In the United States, NETs are traditionally seen under the rubric of oncology. In the rest of the world NETs are not primarily driven by oncology. By the time the tumor is widely metastatic, traditionally the patient would see an oncologist, but patients with early-stage disease see surgery, gastroenterology, interventional radiology, and other specialties.

It’s a bit of a change as to how the structure of our organization has gone. It started off with a group of oncologists and it’s now expanding to be more inclusive, and we’ve developed relationships with other organizations. For example, at our meeting we’ve got a symposium with the Society of Nuclear Medicine and Molecular Imaging [SNMMI], and we have another co-session with the World Conference on Interventional Oncology [WCIO] for interventional radiologists. We are trying to foster relationships with other subspecialties while still maintaining our identity as the guardians of the clinical care of neuroendocrine disease.

We’ve also partnered over the years with the European NET Society (ENETS) and every other year we share a young investigator symposium with them. This year was their chance but there will be next year, and we’re also developing relationships with other professional organizations. We’ve had collaborations with the Commonwealth Neuroendocrine Tumor Group of Australia, New Zealand, and Canada [CommNETS] and we’re publishing some state-of-the-art consensus conference papers with them. We plan to spread our influence as much as we possibly can to spread awareness about the disease process.

TARGETED ONCOLOGY:How will physicians from all disciplines benefit from taking part?

Metz:To give you an example, at my own institution I direct my neuroendocrine program, but when I have a tumor board once a month, it’s maybe 15 or 20 disciplines sitting around a table—surgeons, endocrinology, conventional radiology, nuclear medicine, genetics, etc. We’re trying to make sure that as it grows, we can represent that big group.

The reason that’s challenging is if you’re, say, an oncologist, your primary role is to be an oncologist, and that is to join the American Society of Clinical Oncology, or if you’re a gastroenterologist, you’re a member of the American Gastroenterological Association, and then the same goes for all the disciplines. There’s only so many neuroendocrinologists in the country that can truly say that a majority of our work falls within that sphere, whatever our subspecialty is. So, the challenge is to be broad and inclusive, but at the same time to have enough guests within each specialty to attract the specialists of each type to come to our subspecialty neuroendocrinology program. But we are the only forum for that and that’s why our program is growing.

We are the only truly clinically-based, physician-driven education and research organization for neuroendocrine cancers.

TARGETED ONCOLOGY:What will attendees gain from attending the symposium?

Metz:There’s tremendous benefits. If you’re coming as a young investigator you can learn about how to potentially get grants, learn new science, and develop contacts. Others can network and communicate within their field across disciplines. If you’re on the pharma side, you’re getting exposure to experts to develop an understanding of your drugs, for example. If you’re an epidemiologist, you get to look at some survey information. There’s education for people who are newly interested, there’s cutting-edge information about the latest and greatest as well as the most basic of basic science. I think there’s something in it for everyone, it all depends where you’re coming from.

The beauty of this, I think, is that it’s a very comprehensive broad presentation of all sorts of different levels so I think there’s much to be gained. I’ve been coming to NANETS for about the last 6 years or so, and each year it’s better than the one before, so this is going to be a great program.

TARGETED ONCOLOGY:What are some of the most exciting areas of research that will be covered? Which sessions are you excited to attend?

Metz:There’s a state-of-the-art lecture that’s being given by Aldo Scarpa, MD, PhD, to establish the landmark genetics of NETs about which we really don’t know much and which really has moved the needle forward in terms of some of the basic science with promise for translational work in the future, so that’s a particular talk I’m really looking forward to hearing.

The young investigator symposium that I’m talking at, I’m looking forward to that because I think it’s going to be at a level of practicality of how you get things moving and make a career out of medicine and neuroendocrinology specifically.

We have some wonderful basic science and clinical research projects, we have various mini symposia, in addition to the shared symposia I mentioned, where we will have people presenting their personal high-quality research. There’s a lot of new agents that are out and being evaluated. We’re very excited about nuclear medicine in this field and with the new arrival of gallium dotatate scans. We also have a session for the latest experience with scanning and imaging.

We are all excited about the future of peptide receptor radionuclide therapy, which is going to change the whole treatment landscape in the United States—we’ll no longer have to send our patients to Europe anymore. Once this gets proved and rolled out, hopefully in the new year, that’s going to change the whole treatment paradigm, so there’ll be data about the quality of life related to that, and for new agents in terms of symptom control for patients with functional carcinoid tumors, and there’s more information coming out regarding those agents. From a diagnostic perspective and clinical management position, this is interesting stuff, and then there’s all the collaborative sessions—interventional radiology approaches, the SNMMI conference is going to be exciting, and the basic science work is going to be interesting.

We’ve got rotating areas of interest each year to address the standard state-of-the-art research that one discipline might think is a simple slam dunk that another might not know anything. This year we’re doing some gastroenterology sessions, one of which I’m chairing, on simple things like diarrhea. Fifteen percent of people who go to a hospital come with a change in bowel movements, and a portion of this giant number of people are those with carcinoid syndrome, gastrinoma, or some of the newer neuroendocrine tumors. How you make the average physician out there think about these diseases and consider looking for them is important because if you don’t look for them, you’re not going to find them, and they’re so rare.

There’s also some interest in another even rarer NET—the pheochromocytoma, and we’ve gotten a lot of recent interest in lung carcinoids because they’re actually quite common and they don’t ever really have a standalone voice because many oncologists in the lung area are treating lung cancer, so that’s another area where we want to be growing.

We also are celebrating our 10th anniversary, which is a big deal for us because we’re a young organization but we’ve now suddenly grown up. We’re going to have a big 10th anniversary celebration Friday night and we’ve got an anniversary lunch on Saturday.