Clinical Advances in Hematology & OncologyHighlights in Neuroendocrine Tumors From the 2024 North American Neuroendocrine Tumor Society (NANETS) Multidisciplinary NET Medical Symposium

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The 2024 North American Neuroendocrine Tumor Society (NANETS) Multidisciplinary NET Medical Symposium presented significant clinical trial results and research advances in neuroendocrine tumor (NET) treatment. Dr. Jennifer Chan from Dana-Farber Cancer Institute reviewed developments across basic science, clinical trials, observational studies, and clinical guidelines, with particular focus on new therapeutic approaches including 177Lu-Dotatate and cabozantinib.

Key Points:

• The NETTER-2 trial demonstrated superior efficacy of 177Lu-Dotatate plus octreotide LAR versus high-dose octreotide LAR alone in advanced GEP-NETs, showing median PFS of 22.8 vs 8.5 months (HR, 0.276; P<.0001) and ORR of 43.0% vs 9.3% (P<.0001).
• The phase 3 CABINET trial validated cabozantinib’s effectiveness in previously treated progressive advanced NETs, with significant PFS improvements in both extrapancreatic NET and pancreatic NET cohorts compared to placebo.
• Recent molecular studies revealed new potential therapeutic targets, including ASCL1 as a biomarker for B-cell lymphoma 2 inhibitor response in pulmonary NETs and alternative immune checkpoints (VISTA, TIM3, Gal-9, SIGLEC10) in GEP-NETs.
• The LITESPARK-004 trial showed promising results for belzutifan in VHL disease-associated pancreatic lesions, with 84% ORR in pancreatic lesions and 91% in pNETs after 37.8 months median follow-up.
• New research indicates vasopressors should be first-line treatment for intraoperative carcinoid crisis, with data showing 30% crisis rate in patients receiving first-line octreotide versus significantly better outcomes with first-line vasopressors.

HCN Medical Memo
The landscape of NET treatment continues to evolve with robust clinical trial data supporting new therapeutic approaches. The demonstrated efficacy of 177Lu-Dotatate and cabozantinib, combined with advances in molecular understanding, provides clinicians with expanded options for personalized treatment strategies.

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