Factors to Consider When Selecting Therapy for NETs
Robert Ramirez, DO, FACP: When I first see a patient with a neuroendocrine tumor, there are several factors that I look at. One is, is this tumor localized? Is this something curable, or has this spread beyond the original site? My goals vary. I ask myself the same 3 questions about any cancer patient I see. One, can this patient be cured? Two, if they cannot be cured, do I have some sort of treatment that is going to at least improve or maintain their quality of life? And three, can I make this patient live longer? Those are the 3 things that come to mind right off the bat.
Neuroendocrine tumors are a little bit different from some of the other traditional cancers that we see. Most of the time when I see patients with neuroendocrine tumors, the cancer has already spread. I know at that point that this is going to be a long journey for the patient, and the hope is to again maintain or improve that quality of life and keep them going for as long as possible. There are several different ways that we do that with neuroendocrine tumors. The first thing is that right off the bat, I look at what they look like. Can this patient tolerate any sort of therapy? I ask, “Well, what kind of therapy do I have to offer this patient?” Some of that depends on the pathology. Is this a slow-growing tumor that I have time to send to different specialists and use different treatments on, or is this a very high-grade, poorly differentiated tumor where I need to start the patient on chemotherapy tomorrow? That is the first thing I look at.
Many times, neuroendocrine tumors tend to be on that slow-growing side. I work in a specialized center that has a multidisciplinary approach. We have a tumor board every week where we talk about our patients and come up with treatment decisions as a team, and that’s very, very important in this disease. I work with my surgeons, my GI [gastrointestinal] doctors, my radiologists, and my nutritionists, and we all get on the same page and figure out the best way to move forward with treatment.