Expert Point of View: Hagan Kennecke, MD, Pamela L. Kunz, MD, and George Fisher, MD, PhD


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Hagan Kennecke, MD

Pamela L. Kunz, MD

George Fisher, MD, PhD

It was important to see the detailed subgroup analysis for pancreatic neuroendocrine tumors, because that is a major patient population we treat, and it was not included in the PROMID study.

—Hagan Kennecke, MD

Hagan Kennecke, MD, Associate Professor, University of British Columbia at the British Columbia Cancer Agency, said in an interview, “It was important to see the detailed subgroup analysis for pancreatic neuroendocrine tumors, because that is a major patient population we treat, and it was not included in the PROMID study. You cannot automatically assume that all (neuroendocrine) tumors respond the same,” since somatostatin-receptor activity may vary among subtypes.

Pamela L. Kunz, MD, Assistant Professor of Medicine/Oncology at Stanford University School of Medicine, also an expert in neuroendocrine tumors, noted that the two somatostatin analogs have “very similar mechanisms of action and affinity for the somatostatin receptors 2 and 5, and the National Comprehensive Cancer Network (NCCN) guidelines use them interchangeably.” She said their antiproliferative benefits are “likely a class effect, but lanreotide has the FDA label [as an antiproliferative].”

George Fisher, MD, PhD, Professor of Medicine (Oncology) at Stanford University Medical Center and Director of the Oncology Clinic, who moderated the session, said he would view the two somatostatin analogs as “interchangeable,” unless additional data reveal differences between them. He maintained that many asymptomatic patients, as were enrolled in CLARINET, do not need treatment but can be followed. “There is nothing you lose by observing asymptomatic patients with small-volume disease,” he said. “If a subsequent scan shows stable disease, then therapy with a somatostatin analog may have been unnecessary, and if it shows progressive disease, therapy could safely be initiated at that point,” he said. ■

Disclosure: Drs. Kennecke and Fisher reported no potential conflicts of interest. Dr. Kunz is on the advisory boards of Ipsen and Novartis and has received research funding from Genentech, Merck, Advanced Accelerator Applications, Lexicon, and Pharm Olam.

 


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