Lowell B. Anthony, MD, FACP, chief, Division of Medical Oncology, University of Kentucky Markey Cancer Center, discusses preliminary research with spartalizumab (PDR001) in neuroendocrine tumors (NETs).

An ongoing area of research in this space is immunotherapy. In a phase II study (NCT02955069) presented at the 2018 ESMO Congress, the safety and efficacy of spartalizumab was examined in patients with advanced NETs. Data indicated a benefit for those with thoracic NETs, says Anthony.

Spartalizumab is a PD-L1/2 inhibitor and a monoclonal antibody. The agent has been tested in prospective randomized trials in not only 3 primary sites, but also in nondifferentiated NETs, says Anthony. From the phase II trial that was done, investigators now know that responses were more pronounced in these thoracic primaries. Historically, another trial with pembrolizumab (Keytruda) showed response rates around 6% to 12%. However, it is not entirely clear whether this will translate to practice as these are early signals, concludes Anthony.

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Dr. Anthony on Spartalizumab in 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.

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.

Lowell B. Anthony, MD, FACP

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Dr. Anthony on Spartalizumab in NETs

Dr. Anthony on Sequencing Strategies for Patients With NETs