NF-PanNETs are more common than their functional counterparts. NF-PanNETs display variable biological behaviour, ranging from indolent, small, and asymptomatic tumours, which can be managed through active surveillance, to aggressive lesions requiring radical surgical treatment. The recurrence rate after surgery is around 20–30%. No established adjuvant therapy protocols are available to reduce this risk. Thus why the trial is interesting, albeit only on a small cohort of patients. 

It’s also interesting because most guidelines urge caution in surgical intervention in many NF-PanNETs less than 2cm. However, the clinical trial document confirms the target population:

• Radiological tumour size > 40 mm
• Well differentiated G2 NF-PanNETs with Ki67 >10% or well differentiated NF-PanNETs G3

And it would be remiss of me to exclude the output of the NETTER-2 clinical trial where it was suggesting a neoadjuvant approach to Grade 2 and 3 NETs using SSTR radioligand therapy (PRRT) as a first line treatment.  The output from that trial said “There are currently no standard first-line treatment options for patients with higher grade 2–3, well-differentiated, advanced, gastroenteropancreatic neuroendocrine tumours. We aimed to investigate the efficacy and safety of first-line [¹⁷⁷Lu]Lu-DOTA-TATE (¹⁷⁷Lu-Dotatate) treatment.” and then concluded “First-line ¹⁷⁷Lu-Dotatate plus octreotide LAR significantly extended median progression-free survival (by 14 months) in patients with grade 2 or 3 advanced gastroenteropancreatic neuroendocrine tumours. ¹⁷⁷Lu-Dotatate should be considered a new standard of care in first-line therapy in this population.”

Read the cited NEOLUPANET study below (click on the blue highlighted text).