Dr. Yao on Everolimus in Advanced Pancreatic NET

James C. Yao, MD, Associate Professor, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, describes the administration of the mTOR inhibitor everolimus (Afinitor) for patients with pancreatic neuroendocrine tumors (NET).

Several trials have examined everolimus in patients with pancreatic NET, Yao explains. The phase III RADIANT-3 trial examined everolimus compared to placebo in 410 patients. This trial was instrumental in the approval of everolimus in unresectable, locally advanced or metastatic pancreatic NET.

The other available options for pancreatic NET include sunitinib (Sutent) and chemotherapy. Yao believes that sunitinib and everolimus are generally better treatment options than chemotherapy; however, a study has not yet compared everolimus to sunitinib. To determine the most appropriate sequence for the two agents, since a study does not exist, it is important to individualize treatment based on the patient's adverse event profile, Yao explains.

As an example, Yao states, patients with cardiac issues should not receive sunitinib, since it is a VEGF inhibitor. Likewise, patients with lung disease are not good candidates for everolimus. Additionally, the levels of hormone secretion could also be considered as a sequencing tool, since studies have indicated that treatment with everolimus may reduce hormone output in patients with pancreatic NET.