First-Line Treatment and Standard of Care for NETS

The discussion focused on frontline management of newly diagnosed neuroendocrine tumor (NET) patients, emphasizing the heterogeneity of these tumors and the need for individualized care. For grade 1–2, low-burden, nonfunctional tumors, observation is often appropriate to assess disease biology and pace. Functional tumors, even if low-volume, typically require somatostatin analogs (SSAs) to control symptoms. Surgery and local therapies are highlighted as frontline options for liver-dominant or debulkable disease, offering potential long-term benefit. For higher-burden or symptomatic tumors, systemic therapies like capecitabine-temozolomide may be considered, especially in pancreatic NETs. A key challenge discussed is low-grade tumors lacking somatostatin receptor (SSTR) expression, where SSA use is controversial and decisions may rely on FDG PET, functional symptoms, and tumor site. Site of origin (small bowel, pancreas, lung) also influences imaging interpretation, SSTR expression likelihood, and treatment selection, reinforcing that NET management requires careful, patient-specific decision-making rather than a one-size-fits-all approach.