Neuroendocrine Tumors   

Assume the patient is young and active.

How aggressive should we be in bringing elevated plasma/urine 5HIAA to normal levels in patients whose symptoms are controlled? Before we have the res...

Would the grade of the lesion affect your decision?

Does DOTATATE scan results/burden of disease change your preference?

Or use baseline PET followed by serial MRI/CT for monitoring?

 If so, how long would you treat? 

Would a negative dotatate PET change management for a patient for whom you were planning to start SSAs?

For this example, Ki-67 of 80, MSS, low TMB

Do somatotatin analogues work in this scenario?

Do you drop or adjust the temozolomide at any point, or rather continue to progression as long as temozolomide is well tolerated?

Which patients would you recommend active surveillance alone, a less morbid procedure such as enucleation, or a Whipple surgery? How does age influenc...

Pathology details: 75% high grade large cell neuroendocrine tumor of the cecum (20-30 mitoses per 10 hpf, Ki67 75%) and 25% adenocarcinoma. Patient ha...

What therapy would you offer if the patient had a baseline grade 2 neuropathy?

Would there be any benefit to surgery in a healthy/good PS patient? There is so little data on pulmonary atypical carcinoid and radiation respons...

What would you offer in the setting of bulky liver metastases?

Would you use a small cell regimen over a more traditional FOLFOX-esque approach?

Is there a distinction between these tumors and patients with breast cancer with neuroendocrine features?

Does the advent of more effective therapies like peptide receptor radioligand therapy (PRRT) and capecitabine and temozolomide (CAPTEM) dampen enthusi...

Liver and skeletal metastasis with no disease in the lung.

If so, are there particular patient/tumor characteristics that influence your decision?

Would you treat with typical small cell paradigms such as surgery followed by adjuvant platinum doublet +/- radiation vs definitive chemoradiation? Or...

Would the presence of peritoneal carcinomatosis change your treatment strategy? If Ki-67 <50%, would you avoid platinum based cytotoxics?

Would you consider first line treatment with somatostatin analog or Lu 177 dotatate? Is observation an option for asymptomatic patients?

Given the variable and sometimes indolent disease course of these patients, as well as the absence of a clear overall survival benefit in the PROMID&n...

There is some data on TMZ and 5FU based regimens, but convincing evidence is lacking. How would you approach this situation?