Disease Progression

IDENTIFY APPROPRIATE PATIENTS FOR LUTATHERA EARLY

Monitor for Progression

Proactively Monitoring for Progression, Regardless of Recurrent or Worsening Symptoms

Proactive monitoring for disease progression is important when treating patients with GEP-NETs^1,2

Potential Methods of Identifying and Monitoring Disease Progression
Recurrent or increased symptoms	Potential symptoms due to: Functional carcinoid tumors³
	Flushing	Diarrhea	Abdominal pain
	Wheezing	Palpitations
	Potential symptoms due to: Recurrence⁴
	Fatigue	Dyspnea	Pain
	These symptoms may also be seen at the initial presentation. This is not a comprehensive list and is provided only as a general recommendation.

Biomarker identification	May provide an indication of possible progression⁵

	Chromogranin A	5-hydroxyindoleacetic acid

Radiological evaluation	Use of multiple imaging modalities and clinical assessment provides objective measurement of tumor size and might detect new lesions^6,7
	CT scan	MRI scan	SSTR imaging

Close monitoring may help you identify the appropriate time to consider different treatment options for patients who are progressing.⁸

Proactively Monitoring for Progression,
Regardless of Recurrent or Worsening Symptoms^2,8-10

Symptoms associated with NETs may be nonspecific or absent until more advanced stages of disease. Progression may not be correlated with symptoms, so proactive monitoring may determine the right time for a change of treatment.

Identify Appropriate Patients for LUTATHERA Early

Take Action With LUTATHERA After First-Line SSA Therapy

Many patients with GEP-NETs are diagnosed with late-stage disease. Time matters—consider LUTATHERA after first progression on an SSA before patients become ineligible.^2,11

Patient eligible for LUTATHERA	Patient not eligible for LUTATHERA
Emily	Maggie

Referred for LUTATHERA immediately after progressing on first-line SSA therapy	Referred for LUTATHERA after progressing on multiple therapies, but deemed ineligible for LUTATHERA due to development of renal failure requiring dialysis Not actual patients.

Patient Profiles

How to Identify Potential Patients for Treatment With LUTATHERA

After a patient with GEP-NET progresses following first-line SSA therapy, there may be multiple treatment options to consider for the next step. However, only certain patients may be appropriate candidates for treatment with LUTATHERA.¹²

Consider LUTATHERA for adults with SSTR-positive GEP-NETs, including foregut, midgut, and hindgut NETs. The table below outlines the characteristics of patients who were studied in the NETTER-1 clinical trial.¹²

Do any of your patients fit these criteria?

Category	Characteristics of Patients in the NETTER-1 Trial^12,13
Extent of disease	Operable		Inoperable
Location of disease	Metastatic		Locally advanced
Pace of growth	Stable		Progressive
Primary site	Midgut
Grade	Low	Intermediate		High
Differentiation	Well differentiated		Poorly differentiated
Hormone status	Functional		Nonfunctional
SSTR expression	Positive		Negative

Table Key

Included in clinical trial

Excluded from clinical trial

Next: Efficacy

CT, computed tomography; GEP-NETs, gastroenteropancreatic neuroendocrine tumors; MRI, magnetic resonance imaging; NETs, neuroendocrine tumors; SSA, somatostatin analog; SSTR, somatostatin receptor.

References: 1. Garcia-Carbonero R, Capdevila J, Crespo-Herrero G, et al. Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE). Ann Oncol. 2010;21(9):1794-1803. 2. Sackstein PE, O’Neil DS, Neuget AI, Chabot J, Fojo T. Epidemiologic trends in neuroendocrine tumors: an examination of incidence rates and survival of specific patient subgroups over the past 20 years. Semin Oncol. 2018;45(4):249-258. 3. Toumpanakis C, Garland J, Marelli L, et al. Long-term results of patients with malignant carcinoid syndrome receiving octreotide LAR. Aliment Pharmacol Ther. 2009;30(7):733-740. 4. Cancer.net. Neuroendocrine tumors: statistics. Accessed February 24, 2022. https://www.cancer.net/cancer-types/neuroendocrine-tumors/statistics 5. Vinik AI, Woltering EA, Warner RRP, et al. NANETS consensus guidelines for the diagnosis of neuroendocrine tumor. Pancreas. 2010;39(6):713-734. 6. Panzuto F, Falconi M, Nasoni S, et al. Staging of digestive endocrine tumours using helical computed tomography and somatostatin receptor scintigraphy. Ann Oncol. 2003;14(4):586-591. 7. Dromain C, de Baere T, Lumbroso J, et al. Detection of liver metastases from endocrine tumors: a prospective comparison of somatostatin receptor scintigraphy, computed tomography, and magnetic resonance imaging. J Clin Oncol. 2005;23(1):70-78. 8. Merino-Casabiel X, Aller J, Arbizu J, et al. Consensus document on the progression and treatment response criteria in gastroenteropancreatic neuroendocrine tumors. Clin Transl Oncol. 2018;20(12):1522-1528. 9. Wolin EM, Leyden J, Goldstein G, Kolarova T, Hollander R, Warner RRP. Patient-reported experience of diagnosis, management, and burden of neuroendocrine tumors: results from a large patient survey in the United States. Pancreas. 2017;46(5):639-647. 10. Ter-Minassian M, Zhang S, Brooks NV, et al. Association between tumor progression endpoints and overall survival in patients with advanced neuroendocrine tumors. Oncologist. 2017;22(2):165-172. 11. Hope TA, Bodei L, Chan JA, et al. NANETS/SNMMI consensus statement on patient selection and appropriate use of ¹⁷⁷Lu- DOTATATE peptide receptor radionuclide therapy. J Nucl Med. 2020;61(2):222-227. 12. Lutathera. Prescribing information. Novartis Pharmaceuticals Corp. 13. Strosberg J, El-Haddad G, Wolin E, et al; for the NETTER-1 trial investigators. Phase 3 trial of ¹⁷⁷Lu-dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376(2):125-135.