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Accreditation/ Credit Designation

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. These activites are not approved for AMA PRA Category 1 Credit

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.


Oncology Briefings™: Updates in Novel Therapeutic Options for Lung Neuroendocrine Tumors PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap


Criteria in Risk Stratification of Lung NETs

The online Oncology Briefings™ CME activity, Updates in Novel Therapeutic Options for Lung Neuroendocrine Tumors, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving treatment standards in lung neuroendocrine tumors (NETs). Leading expert Jonathan R. Strosberg, MD, associate professor and head of the Gastrointestinal Department Research Program at H. Lee Moffitt Cancer Center, Tampa, FL, answers key questions supported by the presentation of clinical science about lung NETs. This first of 3 PER Pulse™ Recaps from this program focuses on important criteria in the stratification of lung NETs.

Dr. Strosberg presented diagnostic criteria using standards delineated in the World Health Organization (WHO) 2015 criteria, and provided his insights on this topic, comparing the current stratification to that which exists in gastrointestinal (GI) NETs:

  • Typical carcinoids (TCs) are well-differentiated neoplasms characterized by less than 2 mitoses per 2 mm2 observed field and an absence of necrosis. Typical carcinoids are similar in grading to low-grade NETs in the GI tract.
  • Atypical carcinoids (ACs) are well-differentiated neoplasms characterized by 2 to 10 mitoses per observed field and display focal necrosis. Atypical carcinoids are similar in grading to intermediate-grade ones.
  • Large-cell neuroendocrine carcinomas (LCNECs) are poorly differentiated tumors characterized by a high mitotic rate (median of 70 per observed field) and extensive necrosis. Large-cell neuroendocrine carcinomas correspond to high-grade GI NETs.
  • Small cell lung cancers (SCLCs) also are poorly differentiated tumors characterized by a high mitotic rate (median of 80 per observed field) and extensive necrosis, but are morphologically distinct from LCNECs. Small cell lung cancer corresponds to high-grade GI NETs.
  • Gastrointestinal NETs have 2 separate classification criteria for grade and differentiation. Additionally, GI NETs rely on the immunohistochemical proliferation marker ki-67 in determining pathology.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-updates-in-novel-therapeutic-options-for-lung-neuroendocrine-tumors.

For information on other topics, visit www.gotoper.com.


2 of 3
PER Pulse™ Recap

Current Management Strategies in Lung NETs

The online Oncology Briefings™ CME activity, Updates in Novel Therapeutic Options for Lung Neuroendocrine Tumors, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving treatment standards in lung neuroendocrine tumors (NETs). Leading expert Jonathan R. Strosberg, MD, associate professor and head of the Gastrointestinal Department Research Program at H. Lee Moffitt Cancer Center, Tampa, FL, answers key questions supported by the presentation of clinical science about lung NETs. This second of 3 PER Pulse™ Recaps from this program focuses on the treatment and management strategies considered standard in the field of lung NETs.

Dr. Strosberg presented the essential takeaways from 2011’s practice-changing, phase 3 RADIANT-4 trial evaluating everolimus, an oral inhibitor of mammalian target of rapamycin, resulting in the drug’s approval in 2016, specifically:

  • 302 patients with lung or gastrointestinal (GI) NETs were enrolled in the trial: 205 to everolimus, 97 to placebo. Patients were treated with everolimus 10 mg per day orally or with placebo; both trial arms were treated with supportive care at physician discretion.
  • In patients receiving everolimus, progression-free survival (PFS) was 11.0 months (95% CI, 9.2-13.3). In patients receiving placebo, PFS was 3.9 months (95% CI, 3.6-7.4).
  • Overall, everolimus was associated with a 52% reduction in estimated risk of progression/death (HR, 0.48; 95% CI, 0.35-0.67; P <.00001).
  • Specifically, among the 90 patients with lung NETs enrolled, PFS was 9.2 months (95% CI, 6.8-10.9) for those receiving everolimus compared with 3.6 months (95% CI, 1.9-5.1) for those receiving placebo.

Dr. Strosberg also expanded upon the somatostatin analogues octreotide and lanreotide that are used in hormone-producing NETs, the latter of which is being investigated in the phase 3 SPINET trial (NCT02683941), which is currently active and recruiting participants.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-updates-in-novel-therapeutic-options-for-lung-neuroendocrine-tumors.

For information on other topics, visit www.gotoper.com.


3 of 3
PER Pulse™ Recap

Emerging Management Strategies in Lung NETs

The online Oncology Briefings™ CME activity, Updates in Novel Therapeutic Options for Lung Neuroendocrine Tumors, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving treatment standards in lung neuroendocrine tumors (NETs). Leading expert Jonathan R. Strosberg, MD, associate professor and head of the Gastrointestinal Department Research Program at H. Lee Moffitt Cancer Center, Tampa, FL, answers key questions supported by the presentation of clinical science about lung NETs. This third and final PER Pulse™ Recap from this program focuses on the emerging treatment and management strategies in the field of lung NETs.

Beyond the current phase 3 SPINET trial (NCT02683941) investigating lanreotide in patients with lung NETs, Dr. Strosberg discussed the potential for peptide receptor radionucleotide therapy (PRRT) in the treatment of lung NETs:

  • Peptide receptor radionucleotide therapy utilizes a somatostatin analog (SSA) bound to a radiation-emitting isotope, typically yttrium-90 or lutetium-177. The radiolabeled SSA is able to deliver highly targeted radiation to SSTR-expressing tumor cells.
  • While primarily studied in gastrointestinal (GI) NETs, similar responses have been observed in patients with lung NETs receiving PRRT. However, the need remains for a larger investigation into this therapy.
  • A single-institution series investigating the use of PRRT in 114 patients with advanced lung NETs showed a progression-free survival of 28.0 months and an overall survival of 58.8 months.
  • The National Comprehensive Cancer Network and European Neuroendocrine Tumor Society both suggest that PRRT treatment be pursued only after failure of currently approved therapies. Peptide receptor radionucleotide therapy very much remains an investigational drug.

Dr. Strosberg also discussed the debate and investigation into maintenance therapy versus second-line treatment upon progression, and expressed skepticism about the ability of current trials investigating maintenance therapy to prove a survival benefit.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-updates-in-novel-therapeutic-options-for-lung-neuroendocrine-tumors.

For information on other topics, visit www.gotoper.com.





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