Pamela Kunz

Appropriate Use Criteria for Somatostatin Receptor PET Imaging in Neuroendocrine Tumors

NETs nNETs are relatively rare and encompass a heterogeneous group of tumors with an incidence of approximately 7.0 in 100,000 (1,2), although it is increasing. The most common type is gastroenteropancreatic NETs, which are broken down by sites of origin into gastric, pancreatic, small bowel, colorectal, and those of unknown origin. In addition to gastroenteropancreatic NETs, there are many subtypes of NETs, including pheochromocytomas, paragangliomas, medullary thyroid cancer, Merkel cell cancer, and bronchial carcinoids. Given the lack of evidence in other disease subtypes, these AUC will focus on the role of SSTR PET in well-differentiated gastroenteropancreatic NETs. The belief is that SSTR PET will be valuable in many SSTR-positive diseases beyond gastroenteropancreatic NETs, although these other diseases are not covered in the clinical scenarios in this document.

Health-Related Quality of Life in Patients With Progressive Midgut Neuroendocrine Tumors Treated With 177Lu-Dotatate in the Phase III NETTER-1 Trial

Purpose Neuroendocrine tumor (NET) progression is associated with deterioration in quality of life (QoL). We assessed the impact of 177Lu-Dotatate treatment on time to deterioration in health-related QoL. Methods The NETTER-1 trial is an international phase III study in patients with midgut NETs. Patients were randomly assigned to treatment with 177Lu-Dotatate versus high-dose octreotide. European Organisation for Research and Treatment of Cancer quality-of-life questionnaires QLQ C-30 and G.I.NET-21 were assessed during the trial to determine the impact of treatment on health-related QoL. Patients completed the questionnaires at baseline and every 12 weeks until tumor progression. QoL scores were converted to a 100-point scale according to European Organisation for Research and Treatment of Cancer instructions, and individual changes from baseline scores were assessed. Time to QoL deterioration (TTD) was defined as the time from random assignment to the first QoL deterioration ≥ 10 points for each patient in the corresponding domain scale. All analyses were conducted on the intention-to-treat population. Patients with no deterioration were censored at the last QoL assessment date. Results TTD was significantly longer in the 177Lu-Dotatate arm (n = 117) versus the control arm (n = 114) for the following domains: global health status (hazard ratio [HR], 0.406), physical functioning (HR, 0.518), role functioning (HR, 0.580), fatigue (HR, 0.621), pain (HR, 0.566), diarrhea (HR, 0.473), disease-related worries (HR, 0.572), and body image (HR, 0.425). Differences in median TTD were clinically significant in several domains: 28.8 months versus 6.1 months for global health status, and 25.2 months versus 11.5 months for physical functioning. Conclusion This analysis from the NETTER-1 phase III study demonstrates that, in addition to improving progression-free survival, 177Lu-Dotatate provides a significant QoL benefit for patients with progressive midgut NETs compared with high-dose octreotide.

Weight change associated with telotristat ethyl in the treatment of carcinoid syndrome

1University Hospitals Coventry and Warwickshire NHS Trust; 2Zentralklinik Bad Berka; 3Lexicon Pharmaceuticals, Inc.; 4Charité–Universitätsmedizin; 5Friedrich-Alexander-Universität; 6University of Manchester/The Christie NHS Foundation Trust; 7Royal Free Hospital; 8UCSF Helen Diller Family Comprehensive Cancer Center; 9Stanford University; 10University of Kentucky; 11Hospital Universitario Ramón y Cajal; 12Uppsala University; 13Icahn School of Medicine at Mount Sinai; 14Hôpital Edouard Herriot, Hospices Civils de Lyon; 15Dana-Farber Cancer Institute

438PDImproved time to quality of life deterioration in patients with progressive midgut neuroendocrine tumors treated with 177Lu-DOTATATE: The NETTER-1 phase III trial

Improved time to quality of life deterioration in patients with progressive midgut neuroendocrine tumors treated with 177Lu-DOTATATE : The NETTER-1 phase III trial