From the Guidelines
Currently, there is no definitive cure for metastatic neuroendocrine tumors (NETs), but several clinical trials are investigating promising treatments, such as the PRRT (Peptide Receptor Radionuclide Therapy) trials using Lutetium-177 dotatate (Lutathera) which show significant promise, with four treatments given every 8 weeks intravenously, as per the latest guidelines and studies 1. The most recent and highest quality study, published in 2023, recommends doublet chemotherapy for patients with previously untreated, initially unresectable metastatic colorectal cancer (mCRC) 1. However, this study does not specifically address metastatic NETs. Other studies, such as the one published in 2024, discuss treatment options for stage IV non-small cell lung cancer without driver alterations, including immunotherapy and targeted therapy regimens 1. In the context of metastatic NETs, immunotherapy trials combining checkpoint inhibitors like pembrolizumab with targeted therapies are ongoing, and molecular targeted therapy trials using drugs like cabozantinib (60mg daily oral) and surufatinib (300mg daily oral) target specific growth pathways. Some key points to consider when searching for clinical trials for metastatic NETs include:
- Consulting with NET specialists at major cancer centers
- Searching ClinicalTrials.gov using terms like "neuroendocrine tumor metastatic"
- Considering the specific NET type (gastroenteropancreatic, lung, etc.) as eligibility criteria vary based on prior treatments, tumor characteristics, and overall health status It is essential to prioritize the most recent and highest quality studies when making treatment decisions, and the 2023 study published in the Journal of Clinical Oncology provides the most up-to-date recommendations for treatment of patients with metastatic colorectal cancer 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Clinical Trials for Metastatic Cancer Treatment
- The provided studies do not specifically mention a "metastatic net," but they do discuss various clinical trials and treatments for metastatic cancers, including melanoma, breast cancer, and colorectal cancer 2, 3, 4, 5, 6.
- For metastatic melanoma, combination immune checkpoint inhibitor therapy with ipilimumab and nivolumab has shown a ten-year melanoma-specific survival of 52% 2.
- In PD-1-refractory melanoma, treatment options are limited, but emerging therapeutics such as novel engineered oncolytic viral and human leukocyte antigen (HLA)-restricted immune-mediated T-cell therapies show promising clinical benefit in ongoing clinical trials 2.
- For metastatic breast cancer, the addition of immunotherapy to chemotherapy has been shown to improve progression-free survival (PFS) in PD-L1-positive patients, but no significant benefit in overall survival (OS) was observed 6.
- In metastatic colorectal cancer, new options such as Regorafenib and Trifluridine/Tipiracil have entered the therapeutic field, and reintroduction of previously administered therapy is also a valid approach 5.
Ongoing Clinical Trials and Emerging Therapies
- Ongoing clinical trials are investigating the combination of immunotherapy and targeted therapy for metastatic melanoma and breast cancer 2, 3, 4.
- Emerging therapeutics such as personalized, autologous tumor-infiltrating lymphocyte therapy and novel engineered oncolytic viral and human leukocyte antigen (HLA)-restricted immune-mediated T-cell therapies show promising clinical benefit in metastatic melanoma 2.
- The combination of immunotherapy and chemotherapy has been shown to improve PFS in PD-L1-positive metastatic triple-negative breast cancer patients, but further research is needed to determine its effectiveness in other types of metastatic cancer 6.