Dr. Anthony on Sequencing Strategies for Patients With NETs

Lowell B. Anthony, MD, FACP, chief, Division of Medical Oncology, University of Kentucky Markey Cancer Center, discusses sequencing strategies for patients with gastroenteropancreatic neuroendocrine tumors (NETs).

The availability of effective chemotherapies and targeted therapies is such that treating physicians have many options, Anthony says. In today’s landscape, the backbone of treatment is generally octreotide (Sandostatin) and lanreotide (Somatuline Depot). When patients progress on these agents, that’s when sequencing decisions come into play, Anthony notes.

For example, if patients have high bulk and grade 2 disease, then they would probably benefit from capecitabine and temozolomide, potentially prior to a somatostatin analogue. If they have carcinoid syndrome, chemotherapy will typically be given in combination with somatostatin analogues. If a patient progresses on a somatostatin analogue without high tumor bulk, then the use of everolimus or sunitinib (Sutent) becomes a choice. In that instance, it's really physician's choice as there are no data-driven information to reference, says Anthony.