From the Guidelines
The most promising clinical trials for neuroendocrine tumors (NETs) involve peptide receptor radionuclide therapy (PRRT), with the NETTER-2 trial showing a significant increase in progression-free survival (PFS) among patients with G2-G3 GEP NETs treated with PRRT compared to high-dose octreotide. The NETTER-2 trial reported a median PFS of 22.8 months in the PRRT group versus 8.5 months in the high-dose octreotide group, with an objective response rate of 43% in the PRRT group 1. Other ongoing clinical trials, such as the COMPOSE trial, are comparing PRRT with other treatment options like FOLFOX, CAP-TEM, or Everolimus 1. Key factors to consider when evaluating treatment options for NETs include the tumor's grade, primary site, and Ki-67 value, as well as the patient's overall health and treatment history. Some guidelines recommend considering clinical trials as an option for patients with NETs, particularly those with advanced or progressive disease 1. The use of PRRT has been shown to be effective in patients with SRI-positive G1-G2 GEP-NET, and its role in the treatment of G3 NETs is being further explored. In terms of treatment sequencing, some studies suggest that earlier use of PRRT may benefit long-term outcomes, although more research is needed to confirm this 1. Overall, the treatment of NETs is complex and requires a multidisciplinary approach, with consideration of various factors and treatment options to optimize patient outcomes. The most recent and highest-quality studies, such as the NETTER-2 trial, should be prioritized when making treatment decisions, as they provide the most up-to-date and reliable evidence on the effectiveness of different treatment options 1.
From the Research
Promising Clinical Trials for Nets
- The use of insecticide-treated nets (ITNs) has been shown to be effective in reducing malaria transmission, with studies demonstrating a significant reduction in malaria parasite prevalence and incidence 2, 3.
- Indoor residual spraying (IRS) using non-pyrethroid-like insecticides has been found to be effective in reducing malaria prevalence and incidence, particularly in areas where ITNs are failing due to insecticide resistance 2.
- Combination long-lasting insecticidal nets (LLINs) containing pyrethroid plus piperonyl butoxide (PBO) synergist have been shown to be effective in controlling susceptible and pyrethroid-resistant mosquito populations 4.
- The effectiveness of older ITNs (1-2 years old) in preventing malaria infection has been found to be reduced in areas with moderate pyrethroid resistance, highlighting the need for next-generation ITNs with synergists or non-pyrethroid insecticides 5.
Key Findings
- ITNs have been found to reduce child mortality from all causes by 17% compared to no nets, and reduce the incidence of uncomplicated episodes of Plasmodium falciparum malaria by almost a half 3.
- IRS using non-pyrethroid-like insecticides has been found to reduce malaria parasite prevalence by 39% and malaria incidence by 14% compared to ITNs alone 2.
- Combination LLINs have been found to reduce Anopheles gambiae sensu lato (s.l.) indoor resting density and sporozoite rate compared to mono-treated pyrethroid LLINs 4.
Future Directions
- Further studies are needed to evaluate the effectiveness of next-generation ITNs with synergists or non-pyrethroid insecticides in areas with moderate to high pyrethroid resistance 5.
- The use of IRS with non-pyrethroid-like insecticides should be considered as a complementary strategy to ITNs in areas with high malaria transmission and insecticide resistance 2.