Translate
Subscribe to Blog via Email
Ronny Allan
Headline: Roughly 40% of patients with advanced, progressive gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with pembrolizumab (Keytruda) in combination with lanreotide (Somulatine Depot) achieved stable disease, according to results from the phase 1b/2 PLANET clinical trial presented during the 2021 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancer Symposium.
I’ve written about Pembrolizumab (Keytruda) before in my general immunotherapy coverage – click here. I did note they weren’t really having much luck with Neuroendocrine Neoplasms although I do see some success (…. but not enough) in poorly differentiated carcinomas. Well differentiated NETs remain an immunological desert. However, this poster abstract from ASCO GI conference caught my eye.
“Pembrolizumab has antitumor activity in a subset of GEP-NETs patients,” wrote the investigators. “We hypothesized that the lanreotide, by its antitumor effects and reduction of serotonin, a modulator of immunity, would synergize with pembrolizumab in low/intermediate grade GEP-NETs,” wrote the author led by Michael Morse, MD, of Duke Cancer Center.
In the PLANET study (NCT03043664), 22 patients with GEP-NETs who received a median of 2 prior systemic therapies (range 1-9) were treated with 90 mg of lanreotide and 200 mg of pembrolizumab every 3 weeks until disease progression or intolerable toxicity. A median of 6 doses of pembrolizumab (range, 2-15) and 7 doses of lanreotide (range, 2-15) were administered.
Median age at the time of enrollment was 60.9 years (range, 51.1-82.0). Twelve of the patients were male, and 10 were female. To be eligible for the study, participants were required to have a diagnosis of non-resectable, recurrent, or metastatic well- or moderately-differentiated GEP-NETs with disease progression in the last 12 months, received prior somatostatin analogue therapy, a minimum of 1 measurable lesion based on RECIST 1.1 criteria, an ECOG performance status of 0 or 1, adequate organ function, and a tumor mitotic rate of ≤20/10 hpf and/or Ki67 index ≤20%.
Fourteen patients (63.6%) had tumors located within the gastrointestinal tract, of whom 8 patients (36.4%) had their primary tumor site located in the pancreas. The median time since diagnosis for all patients was 5.3 years, with 6 patients having received prior locoregional therapy and 3 patients receiving prior external beam therapy. Of the 12 tumors that were analyzed, 4 had detectable PD-L1 expression and 11 had tumor infiltrating lymphocytes.
PD-L1 expression on a tumour’s cell is one of the mechanisms of immune evasion, since this inhibits functional activity of cytotoxic lymphocytes which will then not attack tumour cells. Tumor-infiltrating lymphocytes are white blood cells that have left the bloodstream and migrated towards a tumour.
The primary end point of the study was overall response rate (ORR), measured according to RECIST 1.1 criteria. Thirty-nine percent of patients showed stable disease (SD) and 52% of patients had progressive disease (PD). ORR, as measured by irRECIST to better assess the effect of immunotherapeutic agents, was 43% SD, 48% PD, with 9% of patients not evaluable.
Secondary end points were progression-free survival (PFS) and overall survival (OS). The median PFS was 5.4 months (95% CI, 1.7-8.3) and median OS at a median follow-up of 15 months was not reached.
Regarding safety, 6 of the 22 patients (27.3%) experienced treatment-related serious adverse events (AEs) including abdominal pain, pneumonitis, colitis, and hyperglycemia, which were all related to treatment with pembrolizumab. The most common treatment-related AE was hypothyroidism (23%), with other notable treatment-related AEs including colitis (9%), hyperglycemia (14%), and pneumonitis (5%). Three patients (13.6%) discontinued treatment due to AEs. No new safety signals were identified in the study. Investigators noted that peripheral blood immune analyses were pending and would be reported subsequently.
“Further studies to identify other approaches to increase the immunogenicity of well/moderately differentiated GEP-NETs are required,” concluded the investigators.
Reference:
Morse M, Halperin DM, Uronis HE, et al. Phase Ib/II study of pembrolizumab with lanreotide depot for advanced, progressive gastroenteropancreatic neuroendocrine tumors (PLANET). Presented at: 2021 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium. January 15–17, 2021; virtual. Abstract 369.
Please note that the results have been appended to the Clinical Trial doc referenced above. The trial is showing as active but not recruiting and that’s most likely because they are assessing whether they can proceed to the next phase. I will keep this blog live to bring you details when they are published.
General Clinical Trials Disclaimer
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided in the clinical trials document. It’s very important to check the trial inclusion and exclusion criteria before making any contact. If you need questions, the articles here is very useful Questions to Ask About Clinical Trials | Cancer.Net
The inclusion of any trial within this blog should not be taken as a recommendation by Ronny Allan.
Top 10 Posts & Pages in the last 48 hours (auto updates) (Click the titles to read them)
Thanks for reading.
Personal Facebook. Like this page please.
Blog Facebook. Like this page please.
Awareness Facebook Like this page please.
Sign up for my newsletters – Click Here
My Diagnosis and Treatment History
Check out my online presentations
Check out my WEGO Health Awards
Check out my Glossary of Terms – click here
Please Share this post for Neuroendocrine Cancer awareness and to help another patient

A Spotlight on Neuroendocrine Cancer Syndromes – Carcinoid Syndrome
What is Carcinoid Syndrome? Carcinoid syndrome (CS) is the most frequent hormonal complication accompanying neuroendocrine neoplasms (NENs) and is defined by chronic diarrhoea and/or flushing in the

Somatostatin Receptor Positive Advanced Bronchial Neuroendocrine Tumors – PRRT vs Everolimus
I was delighted to see this clinical trial which looks at the efficacy of PRRT (Lu177) vs the efficacy of Everolimus (Afinitor). The latter is

Opinion: Let’s attack Cancer metaphors
Since I started blogging, I’ve read dozens of articles on the subject of ‘cancer metaphors’ and in particular their use in describing cancer experiences with

A review of November 2023 on RonnyAllan.NET – Living with Neuroendocrine Cancer
November is always busier as I help spread awareness for 10th Nov (remembering that every day is 10th Nov on my site!). I also managed

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for Digestive Neuroendocrine Carcinoma
This ENETS guidance paper, developed by a multidisciplinary working group, provides up-to-date and practical advice on the diagnosis and management of digestive neuroendocrine carcinoma, based

Neuroendocrine Cancer – Clinical Esoterica
One of the key awareness messages for Neuroendocrine Cancer is the hormonal syndromes that can often accompany the diagnosis for many people. As it’s a

Neuroendocrine Cancer – The F Words
When I first created my blog in April 2014, I had to find some material to lead up to my 84 mile walk (at the

Laughter is the best medicine
Laughter is important. This is a remastered version of one of my early blog posts. It centred on a ‘get-well’ card I received recuperating in

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for gastric neuroendocrine tumours (NETs) G1–G3
The ENETS 2023 guideline for gNETs are combined with the guidelines for Duodenal NET (dNET) due to their close relationship in anatomical terms. Gastric neuroendocrine
A cup of tea
I would also mention those who contributed to my “Tea Fund” which resides on PayPal. You don’t need a PayPal account as you can select a card but don’t forget to select the number of units first (i.e. 1 = £4, 2 = £8, 3 = £12, and so on), plus further on, tick a button to NOT create a PayPal account if you don’t need one. Clearly, if you have a PayPal account, the process is much simpler
Through your generosity, I am able to keep my sites running and provide various services for you. I have some ideas for 2023 but they are not detailed enough to make announcements yet.
This screenshot is from every single post on my website and depending on which machine you are using, it will either be top right of the post or at the bottom (my posts are often long, so scroll down!)