FDA Approves Xermelo for Carcinoid Syndrome Diarrhea in Patients with Metastatic Neuroendocrine Tumors

Excerpt:

“The FDA approved telotristat ethyl tablets for use in combination with somatostatin analog therapy for the treatment of adults with carcinoid syndrome diarrhea.

“The approval is intended for patients with carcinoid syndrome — a rare and debilitating condition that affects people with carcinoid tumors and metastatic neuroendocrine tumors — that somatostatin analog therapy alone inadequately controlled. Carcinoid syndrome occurs in less than 10% of patients with carcinoid tumors. The tumors cause the excess release of the hormone serotonin, resulting in diarrhea, which in turn can lead to weight loss, malnutrition, dehydration and electrolyte imbalance.”

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Cabozantinib Elicits Responses in Neuroendocrine and Carcinoid Tumors

Excerpt:

“In a phase II study reported at the 2017 Gastrointestinal Cancers Symposium, the tyrosine kinase inhibitor cabozantinib (Cometriq) was evaluated in advanced carcinoid and pancreatic neuroendocrine tumors. Radiographic responses to therapy were observed in both tumor subtypes, and compared to other drugs historically used in this setting, progression-free survival data were encouraging, according to Jennifer A. Chan, MD, of Dana-Farber Cancer Institute, Boston.

“Vascular endothelial growth factor (VEGF) pathway inhibitors have shown activity in advanced neuroendocrine tumors. Recent studies have suggested that activation of the MET signaling pathway may also play a role in the growth of neuroendocrine tumors. Increased expression of MET correlates with decreased overall survival in pancreatic neuroendocrine tumors, Dr. Chan noted.”

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CancerConnect Launches Online Community for Patients with Neuroendocrine Tumors

Excerpt:

“OMNI Health Media (OMNI) announces the launch of a new online community on CancerConnect for individuals with neuroendocrine tumors (NET). This community will provide patients and their loved ones with information and support. Join the conversation in the NET community here.

“Although neuroendocrine tumors have historically been considered rare, the incidence of neuroendocrine tumors has been increasing.  Recent statistics suggest that the current number of people with neuroendocrine tumors exceeds 100,000 in the United States—more than the number of people with other, better known cancers like pancreatic or stomach cancer. The increase in NET diagnoses parallels improved diagnosis and treatments around the world.”

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Strosberg Discusses Latest Lutathera Data in Midgut Neuroendocrine Tumors

Excerpt:

“In December 2016, the FDA informed Advanced Accelerator Applications that its new drug application for Lutathera (177Lutetium DOTA-octreotate) as a treatment for patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) would need to be resubmitted.

“The application was based on the phase III NETTER-1 trial, which randomized patients with advanced, progressive, somatostatin receptor-positive midgut NETS to receive either Lutathera (116 patients) plus best supportive care, including octreotide long-acting repeatable (LAR), or octreotide LAR alone (113 patients).”

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Immunotherapy Needs a New Math

Excerpt:

“A group of doctors and other healthcare industry professionals have set out to develop a more efficient tool for assessing the true value of immuno-oncology (I/O) drugs. They note that these drugs often come with high prices that may distract from their advantages over other types of therapy. For example, Kroger Pharmacy is selling the checkpoint inhibitor ipilimumab (Yervoy) for $140 per mg. At the recommended dose of 3 mg/kg for melanoma patients, the total expense can be high. However, ipilimumab is one of the class of I/O drugs that have improved expectations on supportive care costs and survival benefit. The old measures of value may not apply. Therefore, how does one determine whether $140/mg is a fair price for the drug?”

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Cabozantinib Active in Neuroendocrine Tumors

Excerpt:

“In a single-arm phase II study, cabozantinib demonstrated clinical activity in patients with advanced carcinoid and pancreatic neuroendocrine tumors (pNETs). Partial responses (PRs) were observed in 15% of each cohort treated with cabozantinib and stable disease was the best response in about two-thirds of patients.

“Median progression-free survival (PFS) exceeded 20 months in the pNET cohort and was >30 months in the carcinoid tumor cohort, said Jennifer A. Chan, MD, at the 2017 Gastrointestinal (GI) Cancers Symposium.”

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Midgut Neuroendocrine Tumor Prognosis

Excerpt:

“Patients with small intestine neuroendocrine tumors often have mesenteric tumor deposits (MTDs) in the abdomen – discrete tumor nodules that are not connected to the primary tumor. The clinical significance of these tumor deposits has not been thoroughly investigated, and they are not included in the American Joint Committee on Cancer (AJCC) staging system for midgut neuroendocrine tumors.

Chanjuan Shi, M.D., Ph.D., and colleagues examined the prognostic significance of MTDs associated with midgut neuroendocrine tumors in 132 patients. Using pathologic slides from resected tumors and electronic medical records, the researchers reviewed AJCC tumor stage, lymph node and liver metastasis, presence of MTDs and survival data.”

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Cancer-Related Depression

Excerpt:

“Being diagnosed with cancer is a stressful, life-changing event that can evoke feelings of fear, worry, sadness, and anger. Depression gives one feelings of hopelessness and helplessness, disinterest in previously enjoyable activities, and a consistently down and sad mood. Depression often interferes with one’s ability to work, sleep, eat, and enjoy life. Patients with cancer are especially at risk for depression because of the physical changes and limitations from symptoms and treatment as well as of the uncertainty their treatment holds on their lives.”

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How Do We Solve the Crisis in Cancer Communication?

Excerpt:

“Five rounds of the usual chemotherapy/radiation protocol kept Alan Gross alive through decades of living with lymphoma. The treatments were grueling, but he was living proof that science was giving us ways to live with cancer. Then the disease came roaring back, and doctors told him that their medicine no longer worked. They told him to get his affairs in order.

“Every day, thousands of Americans get the end-of-life warning that Alan and his wife, Jane Townsend, heard two years ago. The words are so powerful that they can have a concussive effect, making it hard to hear, to speak, to process information. ‘Your ability to think clearly and concentrate isn’t there,’ Jane told me.”

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