NET Masterclass Ilias Athanasiadis MD Medical Oncologist Director

NET Masterclass Διχογνωμίες στους νευροενδοκρινικούς όγκους Επιθετικές θεραπείες: Νωρίς ή αργά Ilias Athanasiadis, MD Medical Oncologist Director of the Oncology Department MITERA Hospital, HYGEIA Athens, June 6, 2015

Neuroendocrine tumors (NET) • NETs of the gastrointestinal tract, lung and thymus • NETs of the pancreas • NETs of unknown primary • Poorly differentiated high grade NETs/ large or small cell

Survival after resection of PNET by grade (N=310) Presented By Emily Bergsland at 2015 ASCO Annual Meeting

Lanreotide (CLARINET): Phase III in GEPNETs (Ki 67<10%) Presented By Emily Bergsland at 2015 ASCO Annual Meeting

Early vs late • Not too early, not delayed • Clinical judgment required • Clinical trials and consensus guidelines are not informative and not binding

What justifies an aggressive approach • Survival benefit • Quality of life benefit and symptom control • Response rate and progression free survival are weak endpoints, considered to be intermediate • The important parameter of Value

Slide 1 Presented By Michael Porter at 2015 ASCO Annual Meeting

Value Based Health Care Delivery: The Agenda for Oncology Presented By Michael Porter at 2015 ASCO Annual Meeting

Principles of Value-Based Health Care Delivery Presented By Michael Porter at 2015 ASCO Annual Meeting

Progress in the treatment of Pan. Nets Presented By Emily Bergsland at 2015 ASCO Annual Meeting

Advanced Disease: Indications for therapy Presented By Emily Bergsland at 2015 ASCO Annual Meeting

Peptide receptor radiotherapy (PRRT) Presented By Emily Bergsland at 2015 ASCO Annual Meeting

Everolimus in progressive p. NETs (RADIANT-3) Presented By Emily Bergsland at 2015 ASCO Annual Meeting

Sunitinib in progressive p. NETs (Phase III) Presented By Emily Bergsland at 2015 ASCO Annual Meeting

Medical Treatment Outlook for Advanced Pancreatic NETs in 2015 Presented By Diane Reidy at 2015 ASCO Annual Meeting

Randomized Phase II Study of Everolimus vs. Everolimus plus Bevacizumab in Patients with Locally Advanced or Metastatic Pancreatic Neuroendocrine Tumors CALGB 80701 (Alliance) Presented By Eileen O'Reilly at 2015 ASCO Annual Meeting

Receptor TK/ AKT/ m. TOR Pathway in NET Presented By Eileen O'Reilly at 2015 ASCO Annual Meeting

Slide 21 Presented By Eileen O'Reilly at 2015 ASCO Annual Meeting

CALGB 80701: PFS by Treatment Arm (Investigator-Assessed) Presented By Eileen O'Reilly at 2015 ASCO Annual Meeting

Efficacy + Safety: CALGB 80701 Presented By Eileen O'Reilly at 2015 ASCO Annual Meeting

Take home message #1 Presented By Diane Reidy at 2015 ASCO Annual Meeting

Take home message #2 Presented By Diane Reidy at 2015 ASCO Annual Meeting

SWOG S 0518: Phase III Prospective Randomized Comparison of Depot Octreotide plus Interferon Alpha-2 b versus Depot Octreotide plus Bevacizumab in Advanced, Poor Prognosis Carcinoid Patients Presented By Diane Reidy at 2015 ASCO Annual Meeting

Study Design-Phase III Study Presented By Diane Reidy at 2015 ASCO Annual Meeting

PFS by central review Presented By Diane Reidy at 2015 ASCO Annual Meeting

Time to treatment failure (discontinuation for any reason) Presented By Diane Reidy at 2015 ASCO Annual Meeting

Conclusion • I support an early, justified and aggressive approach • Survival, symptom and disease control are the endpoints • Competing risks and priorities are different for each patient • Clinical data and guidelines are important, but clinical judgment based on the principle of value is essential

CALGB 80701 (Alliance): Schema N=148 Presented By Diane Reidy at 2015 ASCO Annual Meeting