Clinical Perspectives on the Treatment of Neuroendocrine Tumors - Episode 11
Treatment Sequencing in Neuroendocrine Tumors
Panelists discuss how recent trials like COMPETE (comparing peptide receptor radionuclide therapy [PRRT] vs everolimus) and other PRRT studies provide additional evidence supporting PRRT’s role, though questions about optimal sequencing with oral agents like cabozantinib remain unanswered and will require real-world experience to resolve.
Grade 3 Neuroendocrine Tumors and Comparative Trials
Recent subgroup analysis from CABINET demonstrated cabozantinib activity in well-differentiated grade 3 neuroendocrine tumors (NETs), a challenging patient population with limited treatment options beyond chemotherapy. This grade 3 cohort showed approximately 25% response rates, providing confidence for use in patients with higher proliferative indices, particularly those lacking adequate somatostatin receptor expression. This represents a significant advance for thoracic NETs and other primaries with aggressive grade 3 biology.
The COMPETE trial compared lutetium-177 dotatate against everolimus in pancreatic NETs, demonstrating PRRT superiority and providing the first pancreatic-specific PRRT data. While outcomes weren’t quite as robust as NETTER-1, the results support regulatory approval and market competition. A separate trial comparing PRRT against sunitinib showed similar PRRT benefits, though these comparisons don’t fully resolve optimal sequencing questions.
These trials provide additional PRRT options with potential approval of lutetium-177 edotreotide, offering market competition and pricing flexibility. However, sequencing questions remain unanswered, as these studies compared PRRT against older standards rather than contemporary options like cabozantinib. Future trials should address clinically relevant comparisons that truly impact practice patterns rather than historical controls.
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