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Disease Progression

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-NETs1,2

Potential Methods of Identifying and Monitoring Disease Progression

Infographic showing the potential methods of identifying and monitoring disease progression, including recurrent or increased symptoms

 

Recurrent or 

increased 

symptoms

Potential symptoms due to:

Functional carcinoid tumors3

Infographic showing the potential methods of identifying and monitoring disease progression, including the symptom flushing

Flushing

Infographic showing the potential methods of identifying and monitoring disease progression, including the symptom diarrhea

Diarrhea

Infographic showing the potential methods of identifying and monitoring disease progression, including the symptom abdominal pain

Abdominal pain

Infographic showing the potential methods of identifying and monitoring disease progression, including the symptom wheezing

Wheezing

Infographic showing the potential methods of identifying and monitoring disease progression, including the symptom palpitations

Palpitations

 

Potential symptoms due to:

Recurrence4

Infographic showing the potential methods of identifying and monitoring disease progression, including the symptom fatigue

Fatigue

Infographic showing the potential methods of identifying and monitoring disease progression, including the symptom dyspnea

Dyspnea

Infographic showing the potential methods of identifying and monitoring disease progression, including the symptom pain

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.

  
Infographic showing the potential methods of identifying and monitoring disease progression, including biomarker information

 

Biomarker

identification

May provide an indication of possible progression5

Infographic showing the potential methods of identifying and monitoring disease progression, including the biomarker Chromogranin A
Infographic showing the potential methods of identifying and monitoring disease progression, including the biomarker 5-hydroxyindoleacetic acid
 

Chromogranin 

A

5-hydroxyindoleacetic

acid

    
Infographic showing the potential methods of identifying and monitoring disease progression, including a radiological evaluation

 

Radiological evaluation

Use of multiple imaging modalities and clinical assessment provides objective measurement of tumor size and might detect new lesions6,7

Infographic showing the potential methods of identifying and monitoring disease progression, including a CT scan radiological evaluation

CT scan

Infographic showing the potential methods of identifying and monitoring disease progression, including an MRI scan radiological evaluation

MRI scan

Infographic showing the potential methods of identifying and monitoring disease progression, including an SSTR imaging radiological evaluation

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 Symptoms2,8-10

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.

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 Trial12,13

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.