How do you approach a metastatic, intermediate grade NET of GI origin with clinically significant tumor burden?  

As there is still no universal consensus around the NET nomenclature, I will start by tackling the definition of intermediate grade and use the ENETS/WHO classification of grade by proliferation status, i.e. mitotic count 2-20 per 10 high-power fields and/or Ki67 3-20% (with the higher of the two be...