Aman Chauhan, MD, a medical oncologist at the University of Kentucky, discusses future directions with Lutathera (lutetium 177-dotatate) in gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

Currently, Lutathera is a standard of care for the treatment of patients with progressive, metastatic GEP-NETs, explains Chauhan. The majority of patients respond well to Lutathera, and the median progression-free survival (PFS) is in the range of 30 to 55 months. 

However, 15% to 20% of patients with GEP-NETs do not respond to Lutathera or have inadequate responses. These patients may include those with disease in the peritoneum and those who progress rapidly following treatment with Lutathera. As such, improving Lutathera to extend the median PFS is an area of need in this space, concludes Chauhan. 

Videos

Aman Chauhan, MD, discusses future directions with Lutathera in gastroenteropancreatic neuroendocrine tumors. 



Dr. Chauhan on Future Directions With Lutathera in GEP-NETs 

Aman Chauhan, MD, a medical oncologist at the University of Kentucky, discusses key recent advances in therapeutics for patients with neuroendocrine tumors (NETs), and points to the future with ongoing combination studies.


Advances across oncology over recent years are finally beginning to trickle down into more rare tumor types, such as NETs, which generally lag behind in drug developments, Chauhan explains. More clinical trials are being conducted in NETs as well, he added. 

Two examples of such studies include combination studies that Chauhan is an investigator of. These include a phase 2 study that is evaluating the combination of telotristat ethyl (Xermelo) and Lutathera (lutetium Lu 177 dotatate) in patients with well-differentiated NETs. Moreover, Chauhan is also excited about a p

hase 1 trial of triapine and Lutathera combined as a treatment for patients with well-differentiated somatostatin receptor-positive gastroenteropancreatic NETs. 

Aman Chauhan, MD, a medical oncologist at the University of Kentucky, discusses key recent advances in therapeutics for patients with neuroendocrine tumors, and points to the future with ongoing combination studies. 

Dr. Chauhan on Key Recent Advances in Neuroendocrine Tumors

Aman Chauhan, MD, a medical oncologist at the University of Kentucky, discusses the role of ​Lutathera (

​The introduction of Lutathera has been a significant advancement in the NETs treatment paradigm, says Chauhan.

The randomized phase 3 NETTER-1 trial, which served as the basis for the regulatory approval of Lutathera in January 2018, showed superior efficacy ​with Lutathera versus high-dose octreotide ​(Sandostatin).

Notably, Lutathera is a radiopharmaceutical where ​a lutetium-177 ​isotope is attached to ​dotatate, a somatostatin analog​, says Chauhan. The agent attaches to somatostatin receptor ​2, which is abundantly found in NETs.

Per the regulatory indication, patients can receive 1 dose of ​intravenous Lutathera every 2 months,​ Chauhan explains.

The therapy continuously emits radiation, causing single​- and double​-stranded DNA damage in tumor cells, ​which kill​s the cells over a period of time, Chauhan concludes.

Aman Chauhan, MD, a medical oncologist at the University of Kentucky, discusses the role of ​Lutathera in neuroendocrine tumors. 

Dr. Chauhan on the Role of Lutathera in NETs

Aman Chauhan, MD, a medical oncologist at University of Kentucky, discusses sequencing decisions when treating patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

Currently, sequencing for patients with GEP-NETs is largely dictated by the presentation or degree of tumor progression. Patients with metastatic disease, especially bone metastases who are symptomatic, would likely be treated with peptide receptor radionuclide therapy upfront, according to Chauhan.

In asymptomatic patients with slow-growing tumors or low-bulk metastatic disease, Chauhan recommends somatostatin analogs and potentially a mTOR inhibitor afterwards before the patient is exposed to radionuclide therapy. Chauhan continues to search for conclusive data to guide sequencing decisions for patients with GEP-NETs.

Aman Chauhan, MD, discusses sequencing decisions when treating patients with gastroenteropancreatic neuroendocrine tumors.

Dr. Chauhan on Sequencing Therapies for GEP-NETs

Aman Chauhan, MD, a medical oncologist at University of Kentucky, discusses the role of somatostatin analogs in treating patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

Somatostatin analogs form the backbone of treatment for patients with GEP-NETs and changed the way these are managed, explains Chauhan. Somatostatin analogs are often used for frontline treatment of patients with GEP-NETs and work well for those with functional and nonfunctional NETs, evident through the randomized CLARINET study, says Chauhan. This phase III study examined lanreotide (Somatuline Depot) versus placebo in patients with metastatic GEP-NETs.

In addition to being effective in treating patients with GEP-NETs, somatostatin analogs are well tolerated with a better safety profile than traditional chemotherapy, targeted therapy, or radiation-based therapy, concludes Chauhan.

Aman Chauhan, MD, discusses the role of somatostatin analogs in treating patients with gastroenteropancreatic neuroendocrine tumors.

Aman Chauhan, MD

Articles

Dr. Chauhan on Future Directions With Lutathera in GEP-NETs

Dr. Chauhan on Key Recent Advances in Neuroendocrine Tumors

Dr. Chauhan on the Role of Lutathera in NETs

Dr. Chauhan on Sequencing Therapies for GEP-NETs

Dr. Chauhan on the Role of Somatostatin Analogs Treating GEP-NETs