INSIGHTS FROM: ZOZO GREENHOLZ, RN; ANDREW E. HENDIFAR, MD; ERIC LIU, MD, FACS; MARIAH MAHOTZ, RN, BSN, OCN
Friday, February 07, 2020
Andrew E. Hendifar, MD: It’s a very exciting time to be a neuroendocrine tumor patient and a neuroendocrine tumor care provider. Now more than ever, multidisciplinary care is essential to the optimal treatment of these patients. We need to enlarge the tent and include more people. We need to talk more among one another. We—medical oncology, surgical oncology, nuclear medicine—have to come up with some guidelines that are generalizable on how to best sequence some of these treatments. Actually, we are answering many of these questions in the cooperative groups currently. You know, what’s best to use first, and second, and third? And in this way, help and provide the best quality type of care to our neuroendocrine tumor patients possible.
The treatment of neuroendocrine tumors is evolving as more practitioners are getting involved in the care. More recently, that includes nuclear medicine. Right now, because of the use of peptide receptor radiotherapy, nuclear medicine has become a part of the multidisciplinary team. They do need a say and have some input into the care of these patients.
Immunotherapy is a topic of incredible interest to our patients, and there are promising findings through the DART study for certain subgroups of patients, particularly high-grade neuroendocrine tumor patients. And our small cell lung cancer patients have immune therapy that has recently been approved in combination with platinum-based chemotherapy. But for the majority of neuroendocrine patients, immunotherapy does not currently have a role. To provide that to our patients outside a clinical trial is not advisable.
Eric Liu, MD, FACS: The future of neuroendocrine, I hope, is as bright as what we’ve seen in the past few years. We definitely need more treatments. The interesting thing is, what can we learn from other types of cancers that can help? We have these new nuclear therapies, so maybe other cancers can benefit from neuroendocrine also. But we’ve also seen an explosion of things like immunotherapy, which has just revolutionized some of our cancers. We’ll have to see how it applies in neuroendocrine. We may need to combine therapies to make them better. We may need to use other, different medicines to make treatments better. Those are all things we’ll have to evaluate. The great thing is, we’re all working together. As people begin to appreciate that neuroendocrine is more important and that more people have it, hopefully more research will go into it.