Dr. Ramirez Discusses Treating Patients With NETs of the Lung

Robert Ramirez, DO, FACP, Ochsner Medical Center, discusses treating patients with neuroendocrine tumors (NETs) of the lung.

Somatostatin analogs are an option for the treatment of patients with lung NETs, as there is retrospective data in the lung space that indicate they may be beneficial for these patients. Ramirez suggests that clinicians put their patients with lung NETs on clinical trials with somatostatin analogs.

One of these clinical trials is the SPINET trial, which is aiming to answer the question of the role of somatostatin analogs in NETs of the lung. Somatostatin analogs have previously shown benefit in NETs of the gastrointestinal tract and pancreas, but there is no definitive data on their impact in the lung. SPINET, which started in February 2016, is planned for an enrollment of 216 patients and is estimated to be completed by August 2019. To be eligible for enrollment, patients with a typical carcinoid tumor must have a mitotic index of <2 mitoses/2 mm2 and patients with an atypical carcinoid must have <10 mitoses/2 mm2 and/or foci of necrosis.

Additionally, there are data that suggests that the mTOR inhibitors everolimus (Afinitor) prolongs progression-free survival in patients with NETs of the lung. There are also emerging data that suggest peptide receptor radionuclide therapy (PRRT) is beneficial in lung NETs, and that liver-directed therapy and cytoreduction may have a role in treatment as well.