NANETS to Bring All Specialties in the NETs Community Together for 10th Annual Symposium

Michael Soulen, MD

The 2017 North American Neuroendocrine Tumor Society (NANETS) Annual Symposium is kicking off tomorrow, October 19, in Philadelphia with a 3-day lineup of presentations sure to leave professionals in the neuroendocrine community with a better understanding of ongoing neuroendocrine tumor (NET) research efforts, a look at what is on the horizon, and an abundance of networking opportunities with a variety of specialists throughout their field.

In its 10^thyear, the NANETS Symposium has evolved to include an in training/early career program, research didactic sessions, and an expanded look at some of the most exciting clinical research trials happening in NETs. This year’s symposium has a strong focus on the multidisciplinary nature of NETs, with organizers aiming to appeal to not only medical oncologists and surgeons, but all of those involved in the treatment of NETs.

“The big push was a multidisciplinary focus. The reality is neuroendocrine tumors have one of the most diverse set of doctors caring for them, compared to other types of cancer,” said Michael C. Soulen, MD, a member of the NANETS board of directors, the education committee, and the conference organizing committee.

In an interview, Soulen, professor of Radiology and Surgery and director of Interventional Oncology at the Abramson Cancer Center at the University of Pennsylvania, shared some of the biggest topics that will be discussed at this year’s NANETS Symposium, including peptide receptor radionuclide therapy (PRRT) and gallium scanning.

TARGETED ONCOLOGY:How has NANETS evolved since its inception 10 years ago?

Soulen:NANETS started, as many societies do, with a core group of people who had a strong interesting in a niche area. There was no one meeting that really focused on it, so they created one. Ten years ago, NANETS was an old boys and girls club. Basically, people who were focused on the industry who got together to have a meeting. It was mostly driven by medical oncologists and surgeons who are interested in NETs.

Over the years, NANETS gradually grew and became more like a traditional scientific meeting with abstracts. It also diversified and became more multidisciplinary. The whole organization was essentially nurtured by one person, Kari Brendtro, who used to manage the organization. She is a survivor who is a patient advocate for education and progress in NETs. It was sort of a 1-person show, and it grew slowly and incrementally. They added satellite meetings that were 1-day meetings in different cities, where they were trying to focus on bringing that education into different oncologic communities, and they also managed to get a research grant program where they got some very generous donations from pharma to administrate a pretty sizable research grant. They gradually added and diversified their portfolio of things over that 10-year period, but the meeting was still boutique.

After 10 years, they decided it was time to mature and grow and move out of adolescence and they contracted with a large association management firm that runs societies. They professionalized the leadership and got a little bit more discipline around the boards and committees that had grown haphazardly on an as-needed basis without a lot of top-down look at the structure.

That is the evolution that has happened, accelerating much this last year or so. The transition to professional management, becoming a much more traditional medical society, and getting a little bit more discipline and focus around where they are going to go. That has allowed the meeting to grow. Moving into a major medical city like Philadelphia is huge, because you have 6 university health systems and 50 hospitals here, so there is an enormous medical base to draw on locally. Plus, you are in the middle of the mid-Atlantic seaboard, so anyone from New York to DC is within driving distance. That is a big growth location, plus it's a great city to have meetings in, because it's much more economical than other East Coast cities.

The conference is sold out and has a long wait list now. The planning under the old management had not allowed for the meeting to grow this much, so we don't have enough space in the hotel to accommodate the demand now, which is a good problem to have.

TARGETED ONCOLOGY:Are there any themes you see throughout the presentations at this year’s meeting?

Soulen:There are a few. The big push was a multidisciplinary focus. The reality is neuroendocrine tumors have one of the most diverse set of doctors caring for them, compared to other types of cancer. The neuroendocrine tumor board at Penn, where I work, has 25 people on it, because there are so many different specialists involved in this disease, which can happen anywhere on your body.

One of the themes we pushed this year was diversity in terms of specialties, and really trying to make it not a medical oncology or surgery meeting, but really get representation from all the specialists involved. We also really wanted to boost the research side of the program. If you look historically, they would have the 3 key abstracts or papers that got submitted presented and then someone would recapitulate them and give an analysis of them, instead of having broad representation of all the new research being done. We got rid of that old model and put in the sessions where there will be the 10 best papers coming in on that clinical side and on the pre-clinical side, they will all get presented as oral presentations. You really want to highlight all the new emerging stuff, and not just the 3 big trials that weren't even published that everybody knows.

We also added 2 didactic research sessions. Dr Drew Pardoll is coming from Johns Hopkins Hospital, who really is a leader in analyzing the immune system as it relates to pancreatic-based cancers. He is on the list for the Nobel Prize, so getting him to come to NANETS was a huge score. He is one of the science leaders in the interface between the immune system and cancer.

The research session that happens on the next day is also very focused on molecular and genotypic-type things as related to anti-tumor immunity and targets in treating neuroendocrine cancers. Very basic sciency stuff, but that is where all of medical oncology is now, looking at personalized medicine, where you're going to look at that patient's tumor and look at its aberrations that are potentially targetable and choose something that would work for that patient versus something you would generically throw at that type of cancer. I think that's a huge theme throughout the research side of this -- molecular characterization, molecular imaging, molecular targets for therapies, or signaling pathways and metabolizing of tumors that are targetable in some fashion. That is 1 thing that is a big theme, and, of course, the whole sea change in nuclear medicine is starting to have a big impact.

On the clinical side, we have gallium scanning now, so we have a brand new imaging modality that is way more sensitive than anything we have ever had. The problem with all new tests, especially good tests, is that people look at it like a hammer and hit everything with it. They start using it on everybody and the question is, what is this actually good for? There is going to be some focus on that both in the evening sessions and during the daytime sessions. Just because you have a better test, how does that change diagnosis, how does that change prognosis, how does it guide therapy, how does it change surveillance? These are huge controversies. What do you do with this moderately expensive, few thousand dollar test that is now all of a sudden available in the US?

Additionally, there will be discussions on PRRT, the therapeutic side of nuclear imaging. We know it's coming, the trial was completed last year, and we expected it to be approved in the US this year or next year. It's going to be a huge gamechanger in the US in terms of how we sequence therapies and when we are going to do PRRT versus other systemic therapies or liver-directed therapies for people with liver metastases. It's been used in Europe for quite some time, but it will be new for us in terms of actually being part of our treatment algorithm, so that's a huge unknown terrorist that is coming right down the tracks as fast as possible that everyone is going to have to learn to cope with.

TARGETED ONCOLOGY:Can you discuss the keynote lecture that will be delivered by Dr Pardoll?

Soulen:Dr Pardoll’s main focus is immunology in pancreatic cancer and how that knowledge can be used to modify how we treat cancer, because that is such a hot topic. The pancreas is a very hostile microenvironment for drugs and for the immune system. The microenvironment around pancreatic tumors is extremely poorly perfused, extremely high interstitial pressure, and relatively acidic, so it's a very difficult area to target, both with drug therapies and immunotherapies. We do a fair amount of immune-based therapies at Penn, even with CAR T cells, and it's just really hard to get those into pancreatic cancers, because the environment in which the cancer lives is a huge barrier to penetration by therapeutic agents, whether they be drugs or cells. I think the focus from the keynote lecture is how we can modify the immune response or the environment of the cancer itself to allow immune-based therapies to work in pancreatic cancer. It's a very hot topic, and very challenging for everybody.

TARGETED ONCOLOGY:What are you looking forward to at this year's meeting? What do you think attendees will walk away with?

Soulen:For me, particularly more clinical, I think what's really exciting is our ability to really broaden the faculty to be much more multidisciplinary. We're having dedicated sessions with diagnostic radiology colleagues, interventional radiology colleagues, interventional and diagnostic endoscopy colleagues, and nuclear medicine people. By having whole sessions bringing in experts from all these different areas, we're really diversifying the faculty and diversifying the content. What you hope is that will trickle down to a more diversified audience. By broadening the faculty, you kind of do 2 things: 1 is hopefully you broaden the appeal so we can leverage this content to get more people to attend the meeting who are not just medical oncologists or surgeons, but people who practice outside of the cancer environment. They can learn more about neuroendocrine tumors and learn what they have to contribute to the care of neuroendocrine patients and become more sophisticated in their roles in the management of this disease.

The other thing that you accomplish as a secondary gain from these multidisciplinary faculties is that they learn what each other does. The reality is, you come to a meeting like this and everyone comes back to their hospital and they live in their little silos. By forcing them, they sit in the same room for a couple of days. Each of the clinical sessions is focused on diseases, be it GI NETs, lung NETs, or pancreatic NETs. Each of those is a group of different types of specialists, and then it’s a case-based tumor board-type presentation. What that does is it gets all these people who are already thought leaders in their fields to listen to everyone else who is a thought leader in other fields, and exchange these ideas and become aware of what the other people have to offer. And then they take that knowledge back home to their little silos, and then they disseminate it.