Page 16 - Cancer Update Spring 2019 Vol. 8 Issue 1

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A MULTIDISCIPLINARY APPROACH TO NEUROENDOCRINE CANCER
MEDICAL ONCOLOGY
Medical oncologists often serve as the NET patient’s primary contact for the medical system, coordinate and administer medication, and meet with the MDT to develop the treatment strategy. Their precise role depends on the state of the cancer at diagnosis. According to Scott Paulson, MD, co-medical director for the Neuroendocrine Research and Treatment Center at Baylor Dallas, “Fortunately, we have had a large number of new tools become available over just the past several years. Unfortunately, we are not quite sure of the optimal sequence,
and further research is needed to answer those questions. In the meantime, therapies are sequenced based on the specifics of a particular patient’s cancer.”
For late-stage disease, traditional chemotherapies can be the best therapeutic option. Therapies such as everolimus (an mTOR inhibitor), sunitinib (a protein kinase inhibitor), capecitabine (a thymidylate synthetase inhibitor, via metabolism to 5-fluorouracil), and temozolomide (an alkylating agent) also show promise for specific indications. However, earlier stage disease is often indolent and does not respond well to chemotherapy. For these patients, targeted therapies are being heavily pursued. An exciting development for the
treatment of gastroenteropancreatic NETs was the recent approval by the
US Food and Drug Administration (FDA) of the targeted radiopharmaceutical 177Lutetium (Lu)-DOTATATE (Lutathera), which falls into the class of peptide receptor radionuclide therapy (PRRT) (see story on page 24). These agents take advantage of the presence of the somatostatin receptor on the surface of many
8 / Innovative Immuno-Oncology Clinical 13 / A Multidisciplinary Approach 23 / Neuroendocrine Cancer in the Skin: A Publication for Baylor Scott & White Health’s Oncology Program Trial Using Natural Killer Cells to Neuroendocrine Cancer Merkel Cell Carcinoma