James C. Yao, MD, professor, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses a study exploring health-related quality of life (QOL) in patients with neuroendocrine tumors (NETs).

Researchers discussed that patients with active NETs were associated with a decreased QOL. In patients whose tumors were resected and their disease was in remission, their QOL was closer to the general population. It was also found that patients with carcinoid syndrome had QOL issues impacted by their disease.

Further analyses concluded that 2 or 3 bowel movements daily had minimal impact on patient QOL. However, those with 4 or more bowel movements daily had a decreased QOL.

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James C. Yao, MD, professor, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, discusses a study exploring health-related quality of life (QOL) in patients with neuroendocrine tumors (NETs).

Dr. Yao on Health-Related QOL in Patients With Neuroendocrine Tumors

James C. Yao, MD, professor, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses results of the RADIANT-4 study, which examined the safety and efficacy of everolimus in advanced nonfunctional neuroendocrine tumors (NETs) of lung or gastrointestinal (GI) origin.

The area of NETs of lung and GI origin is an unmet need, Yao explains, due to a lack of approved agents that demonstrate clinical activity in these patients. Lung NETs make up 25% to 30% of all patients with NETs. Though somatostatin analogs are available for patients who are treatment-naïve and/or have stable disease, there is a need to treat progressive disease, he explains.

RADIANT-4 randomized approximately 300 patients with aggressive disease 2:1 to everolimus versus placebo. Eligibility criteria included documentation of progression and nonfunctional NETs. Results showed a significance benefit in progression-free survival (PFS), with 7.1 months being the median PFS, Yao says.

James C. Yao, MD, professor, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses results of the RADIANT-4 study, which examined the safety and efficacy of everolimus in advanced nonfunctional neuroendocrine tumors (NETs) of lung or gastrointestinal origin. 

Dr. Yao on the RADIANT-4 Study for NETs of Lung or GI Origin

James C. Yao, MD, professor, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, discusses key takeaways from the RADIANT-3 trial for a community oncologist.

RADIANT-3 showed significant improvement in progression-free and overall survival, including in patients with progressive disease.

After longer follow-up, the safety profile of everolimus looked consistent with what was seen before. Yao notes that a particular interesting fact about everolimus in this space is that an adverse event, stomatitis, was associated with better outcomes for patients. This finding was presented as part of a meta-analysis at the 2014 ASCO meeting.

Dr. Yao on Takeaways From the RADIANT-3 Trial

James C. Yao, MD, Associate Professor, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses an analysis of the linked SEER-Medicare database that examined the benefits and utilization of octreotide LAR as a treatment for patients with carcinoid syndrome associated with neuroendocrine tumors (NET).

Each database has its own advantages, Yao says. The advantage of the SEER database is that it is a rigorous with diagnoses confirmed by pathology and the Medicare database provides access to comorbidity and treatment data.

This study analyzed patients over age 65 who had at least two claims of carcinoid syndrome (flushing, diarrhea, or malignant islet cell neoplasm) within the first year of diagnosis with NET. Patients' first claim also occurred within six months of diagnosis. The population-based analysis looked at whether or not treatment with octreotide was being fully utilized and was beneficial in these patients.

Data showed that a significant portion of the elderly population of patients with carcinoid syndrome, though indicated to be treated with octreotide, were not necessarily getting treated. The study also demonstrated that the patients who received treatment with octreotide had a longer and better five-year survival rate than those who did not. Overall, the five-year survival benefit for distant stage patients was higher with octreotide (hazard ratio [HR] = .80; 

 = .047) compared with local/regional stage patients (HR = .97,

 = .89), suggesting a more appropriate population for treatment.

James C. Yao, MD, Associate Professor, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the analysis of the linked SEER-Medicare database in patients with neuroendocrine tumors.

Dr. Yao on Octreotide in Elderly Patients with 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.

James C. Yao, MD, from the MD Anderson Cancer Center, describes the administration of the mTOR inhibitor everolimus in patients with pancreatic neuroendocrine tumors.

James C. Yao, MD

Articles

Dr. Yao on Health-Related QOL in Patients With Neuroendocrine Tumors

Dr. Yao on the RADIANT-4 Study for NETs of Lung or GI Origin

Dr. Yao on Takeaways From the RADIANT-3 Trial

Dr. Yao on Octreotide in Elderly Patients with NET

Dr. Yao on Everolimus in Advanced Pancreatic NET