Dr. Lagunes on Potential Combinations in the Treatment of Patients With NETs

Diane Reidy Lagunes, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses ongoing clinical trials and recent approvals that will shape the standard of care in the treatment of patients with neuroendocrine tumors (NETs).

An ongoing clinical trial is looking at the use of chemotherapy, specifically the combination of temozolomide (Temodar) plus capecitabine (Xeloda). The trial had a very high response rate of 70%, and though not randomized, questioned whether temozolomide is effective as a single agent, or whether it has to be combined with capecitabine.

The recent FDA approval of peptide receptor radionuclide therapy (PRRT) based on the phase III NETTER-1 trial which compared Lutathera (lutetium Lu 177 dotate) with high-dose octreotide LAR for patients with grade 1 or 2 metastatic midgut NETs will jumpstart an enormous number of treatments. The approval comes in the wake of ongoing studies looking at the combinations of cytotoxic drugs with PRRT which may segue into combinations of PRRT with immunotherapy.