Sequencing of Systemic NETS Treatments

The discussion highlighted the sequencing of therapies for neuroendocrine tumors (NETs) and emphasized a patient-centered, individualized approach. Dr. Hendifar outlined that treatment decisions are guided primarily by tumor differentiation, grade, and disease burden. For low-grade, low-burden NETs, somatostatin analogs (SSAs) remain first-line due to their excellent safety profile and ability to provide disease stability. For intermediate-grade tumors, targeted therapies such as mTOR inhibitors, VEGF tyrosine kinase inhibitors, and peptide receptor radionuclide therapy (PRRT) are often employed. High-grade or poorly differentiated tumors typically require cytotoxic chemotherapy, recognizing its associated toxicities.

Rather than rigid sequencing, the panel emphasized that most patients will eventually receive multiple therapies during their disease course, making exact order less critical. Decisions are informed by patient preferences, comorbidities, treatment tolerability, and healthcare context, reinforcing that NET management is a marathon, not a sprint. This approach ensures therapy balances efficacy, safety, and quality of life.