Bert O’Neil, MD, the Joseph W. and Jackie J. Cusick Professor of Oncology, professor of medicine, and director of the Phase I and Gastrointestinal Oncology Programs at Indiana University, discusses the importance of differentiating between neuroendocrine tumors (NETs).

When discussing NETs of the gastrointestinal tract, it is important to distinguish between tumors that arise in the pancreas and those that arise in other areas, O’Neil says. The tumors that originate in the pancreas have a wide variety of hormone associated syndromes that are separate from carcinoid syndrome, which O’Neil says tends to occur in small bowel NETs.

Another important difference between the 2 types of NETs is their response to therapy. Pancreatic NETs, though more aggressive than small bowel NETs, are more likely to have radiographic responses to targeted therapies and chemotherapeutic agents.

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Dr. O'Neil on Neuroendocrine Tumors

Bert O’Neil, MD, the Joseph W. and Jackie J. Cusick Professor of Oncology, professor of medicine, and director of the Phase I and Gastrointestinal Oncology Programs at Indiana University, discusses the current treatment of patients with colorectal cancer (CRC).

Currently, the average patient with CRC does well on chemotherapy and either a VEGF-targeted agent or an EGFR antibody, says O’Neil. The population that will definitely see a change in treatment is microsatellite instability-high, where immunotherapy may be a factor in the near future. Those studies have yet to read out.

O’Neil says that it is also early days in understanding the role of HER2 expression. Additionally, O’Neil asks whether early intervention is better in patients with 

 mutations. Specific treatments for that population should be considered, he adds.

Bert O’Neil, MD, the Joseph W. and Jackie J. Cusick Professor of Oncology, professor of medicine, and director of the Phase I and Gastrointestinal Oncology Programs at Indiana University, discusses the current treatment of patients with colorectal cancer.

Dr. O'Neil Discusses the Current Treatment of Patients With CRC

Bert O’Neil, MD, the Joseph W. and Jackie J. Cusick Professor of Oncology, professor of medicine, and director of the Phase I and Gastrointestinal Oncology Programs at Indiana University, discusses the development of biomarkers for colorectal cancer (CRC).  

It is too early to state whether a biomarker will matter for combinations for the treatment of patients with CRC, explains O’Neil. Phase III data are needed to further investigate that question, but trials can be difficult to get started. 

Bert O’Neil, MD, the Joseph W. and Jackie J. Cusick Professor of Oncology, professor of medicine, and director of the Phase I and Gastrointestinal Oncology Programs at Indiana University, discusses the development of biomarkers for colorectal cancer (CRC).

Dr. O'Neil Discusses the Development of Biomarkers for CRC 

Bert O’Neil, MD, the Joseph W. and Jackie J. Cusick Professor of Oncology, professor of medicine, and director of the Phase I and Gastrointestinal Oncology Programs at Indiana University, discusses the potential for stemness inhibitors as a treatment for patients with metastatic colorectal cancer (mCRC).

Stemness inhibitors are one of the advances that are really exciting in the field, O'Neil says. This addresses the potential of the Wnt/β-catenin pathway, he adds. Researchers also have conducted a study with the stemness inhibitor napabucasin (BBI-608) in CRC where there seemed to be some signs of preliminary activity. This is currently now in an ongoing phase III study.

There have been other inhibitors being developed of the Wnt/β-catenin pathway, O'Neil says, adding that this is a novel concept for this landscape.

Bert O’Neil, MD, the Joseph W. and Jackie J. Cusick Professor of Oncology, professor of Medicine, and director of the Phase I and Gastrointestinal Oncology Programs at Indiana University, discusses the potential for stemness inhibitors as a treatment for patients with metastatic colorectal cancer (mCRC).

Bert O'Neil, MD

Articles

Dr. O'Neil on Neuroendocrine Tumors

Dr. O'Neil Discusses the Current Treatment of Patients With CRC

Dr. O'Neil Discusses the Development of Biomarkers for CRC

Dr. O'Neil on Stemness Inhibitors for CRC Treatment