Evolving Needs in Advanced NET Care

One of the primary challenges in managing neuroendocrine tumors (NETs) lies in effectively communicating complex information to patients during initial consultations. These appointments often require extended time due to the need to explain the disease trajectory, available treatment options, and likely future developments. While many patients can be managed by community oncologists, maintaining a connection with specialized centers is often beneficial. Clinicians must also tailor their approach based on the patient’s disease characteristics, such as volume and growth rate, and initiate forward planning for future therapies. Importantly, patients’ individual preferences, logistical considerations like proximity to treatment centers, and their tolerance for adverse effects play a critical role in guiding these decisions.

Another key challenge is the limited data available on optimal treatment sequencing. Clinicians often struggle with knowing which therapy to use first, especially since most clinical trials compare new treatments to placebo rather than head-to-head. While some retrospective studies suggest that the overall sequence of treatments may not significantly impact survival, there’s still uncertainty, particularly in higher-grade or rapidly progressing disease. This lack of definitive guidance is further complicated by comorbidities that may affect treatment choices. For instance, therapies like everolimus or tyrosine kinase inhibitors may be inappropriate in patients with poorly controlled diabetes or hypertension, respectively. Therefore, clinicians must often prepare patients by managing underlying health conditions in anticipation of future therapy needs.

A broader systemic issue is the fragmented approval and indication of therapies based on tumor location or functionality, which complicates treatment decisions in community settings. Many drugs are approved only for specific subtypes of NETs—pancreatic, gastrointestinal, or lung—making it difficult for nonspecialists to navigate treatment choices. The ideal scenario would involve having more universally applicable treatments, such as peptide receptor radionuclide therapy (PRRT), which can be used across multiple NET types if the tumor expresses somatostatin receptors. As the incidence and survival of NET patients continue to increase, expanding access to versatile and easy-to-use therapies remains a critical unmet need.