Dr Philip on Considerations for Selecting First-Line Treatment in Newly Diagnosed, Low-Risk GI NETs

“[Treatment decision-making should include] a discussion with the patient because not all patients will agree to [watchful waiting]. Most patients, in my experience, would like [some form of treatment]. In grade 1 disease, I would say the mainstay of treatment is still the somatostatin analog.”

Philip Philip, MD, director, Gastrointestinal (GI) Oncology, co-director, Pancreatic Cancer Center, medical director, Research and Clinical Care Integration, Henry Ford Cancer Institute, discusses considerations for selecting first-line treatment in patients with newly diagnosed, low-risk GI neuroendocrine tumors (NETs).

For patients with grade 1 GI NETs, treatment decisions hinge on tumor characteristics and symptomatology, Philip explains. Asymptomatic patients with incidentally discovered, slow-growing tumors may not require immediate intervention, Philip says. In these cases, watchful waiting, with regular imaging and clinical monitoring over intervals ranging from 3 to 12 months, may be appropriate, he notes. However, this approach requires thorough discussion with patients, as many prefer to initiate treatment even in the absence of symptoms, according to Phillip.

For symptomatic patients, including those with functional symptoms, such as carcinoid syndrome, somatostatin analogues remain the cornerstone of treatment, Philip continues. The combination of somatostatin analogues with peptide receptor radionuclide therapy demonstrated efficacy in the treatment of patients with small intestinal NETs in the phase 3 NETTER-1 trial (NCT01578239).

Somatostatin analogues, such as lanreotide (Somatuline Depot) or long-acting octreotide (Sandostatin), are commonly employed to control symptoms and stabilize disease, Phillip explains. This class of agents is typically well tolerated.

The decision to initiate treatment vs observation is highly individualized and requires shared decision-making between the oncologist and patient, Philip notes. Although many grade 1 NETs exhibit indolent behavior and do not necessitate immediate therapy, patient preferences and quality-of-life considerations play a critical role in the treatment course, he says. Close monitoring and open communication between patients and clinicians are essential to optimizing outcomes in this setting, he concludes.