Expert Point of View: Irvin M. Modlin, MD, and Eric Liu, MD


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Two neuroendocrine tumor experts had slightly different reactions to the latest RADIANT-4 data.

It would be informative to see the outcome of a study undertaken by the National Cancer Institute or an ASCO-designated group using this agent independently.
— Irvin M. Modlin, MD

Irvin M. Modlin, MD, Emeritus Professor of Gastroenterological Surgery at Yale University School of Medicine, New Haven, Connecticut, said in an interview that he essentially restricts his use of everolimus to well-informed patients who ask for the drug. “I applaud the authors for their diligence and careful work in evaluating this agent. Regrettably, the mathematical modelling provides an optimistically overenthusiastic and even misleading picture of the efficacy of the agent,” declared Dr. Modlin. “Despite the statistical gymnastics regarding ‘progression-free survival,’ there is no proven benefit for this agent. Of note is that the criteria by which progression is assessed in neuroendocrine tumors are widely regarded as dubious in their rigor and reproducibility.”

Dr. Modlin continued: “It would be informative to see the outcome of a study undertaken by the National Cancer Institute or an ASCO-designated group using this agent independently, as opposed to that undertaken by individuals supported by the makers of the drug under consideration.”

‘More Tools in the Toolbox’

Now I can treat lung [neuroendocrine tumors], for which there are essentially no treatments, with this new therapy. That’s where the power of RADIANT-4 is for me.
— Eric Liu, MD

Eric Liu, MD, a surgeon at Rocky Mountain Cancer Center, Denver, Colorado, said, “I prefer to have more tools in the toolbox.” The demonstration of benefit for everolimus in a broad range of neuroendocrine tumors is an important finding from RADIANT-4, he added, especially its benefit in lung neuroendocrine tumors.

“This has done me a huge service,” said Dr. Liu. “Now I can treat lung [neuroendocrine tumors], for which there are essentially no treatments, with this new therapy. That’s where the power of RADIANT-4 is for me.”

Commenting on the subgroups analysis presented at the meeting, Dr. Liu said he was pleased to see a benefit for everolimus in midgut tumors. “That’s a little surprising. I’ve never seen it work for midgut [neuroendocrine tumors],” he said, adding that in his experience, the drug works best for foregut tumors. “Now the data show that it does, and I’ll maybe start to rethink the use of it there.” ■

Disclosure: Drs. Modlin and Liu reported no potential conflicts of interest.


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