Hagen F. Kennecke, MD, MHA, FRCPC, a medical oncologist at Virginia Mason Medical Center, discusses the treatments available for patients with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

When patients have advanced disease, they should always consider surgery first and then get staged with Gallium-68 dotatate (Netspot) PET/CT scans, explains Kennecke. If surgery is not possible, patients receive liver-directed therapy followed by targeted treatment, such as Lutetium-177-PSMA-617 plus chemotherapy or targeted therapy with everolimus (Afinitor), says Kennecke.

Sequencing, according to Kennecke, is less important compared with how urgently patients need therapy and how they react to treatment. If patients require debulking surgery, then surgery, liver-directed therapy, or chemotherapy will be most effective. When a patient has more indolent disease that is positive for receptors, they may be eligible for targeted and radiopeptide therapies, concludes Kennecke.

Videos

Hagen F. Kennecke, MD, MHA, FRCPC, discusses the treatments available for patients with advanced gastroenteropancreatic neuroendocrine tumors.

Dr. Kennecke on Available Treatments for GEP-NETs

Hagen F. Kennecke, MD, MHA, FRCPC, a medical oncologist at Virginia Mason Medical Center, discusses multidisciplinary interactions within Virginia Mason Medical Center for patients with gastroenteropancreatic neuroendocrine tumors.

At a weekly tumor board, Kennecke will present a patient’s history, provide their background, and sequentially review pathology. Pathology must be analyzed to ensure the tumor grade is assessed with Ki-67 differentiation. After, imaging is conducted and repeat imaging is ordered if multi-phase CT scans are not completed, says Kennecke.

Then, the Gallium-68 dotatate (Netspot) PET/CT scan is reviewed and a Krenning score is assigned to all patients, grading to tumors from 0 to 4, according to Kennecke. From this evaluation of the patient, the tumor board decides what the best strategy is before discussing with the patients, he concludes.

Hagen F. Kennecke, MD, MHA, FRCPC, discusses multidisciplinary interactions within Virginia Mason Medical Center for patients with gastroenteropancreatic neuroendocrine tumors.

Hagen F. Kennecke, MD, MHA, FRCPC

Articles

Dr. Kennecke on Available Treatments for GEP-NETs

Dr. Kennecke on Suggested Multidisciplinary Actions for GEP-NETs