Despite LNETs increasing in incidence and prevalence, little data exists about natural history and response to various therapies. Management is often based on expert opinion and extrapolation from other NETS. CommNETS and NANETS undertook a rigorous consensus process to endorse and update the 2015 ENETS guidelines (1).
An endorsement approach based on the AGREE II processes (2) was undertaken by a 4 nation, 22 member CommNETS/NANETS panel, including experts from: surgery, pulmonology, medical and radiation oncology, nuclear medicine, pathology, pharmacy and patients/advocates. Two members assessed content and quality of the 52 ENETS statements using the Rigour of Development subscale. A systematic literature and abstract search since 2013 was conducted. Topic experts reviewed relevant ENETS statements and new data, using a patient-centered care perspective and a LNET-specific focus, to provide justification for endorsement or modification and to define a single important unanswered question. Statements were subsequently discussed by the entire panel at a face-to-face meeting and graded using Oxford criteria (3).
230 relevant new studies were identified. Of the 20 ENETS statements relating to management strategies, 4 were endorsed, 16 modified and 3 added (see table). A set of important unanswered questions will inform future studies.Table: 1322P
|Surgery||updated techniques for localized disease modified followup protocol expanded indication for liver cytoreduction|
|Locoregional||optional for slow growing disease|
|Hormone||prophylaxis of carcinoid crisis added|
|PRRT||broadened to all SSTR-expressing tumours|
|Chemotherapy||newer data on temozolomide-based regimens included|
|Targeted||evidence for everolimus upgraded new statement, not supporting use of anti-angiogenics|
|Radiotherapy||palliative use for local symptoms added|
Through the consensus process, guidelines for LNETS were updated to include recent evidence and practice changes. The guidelines provide clear, evidenced based statements to harmonise treatment of LNETS internationally. Refs: 1.Caplin, Ann Oncology (2015):1604-1620. 2. http://www.agreetrust.org/resource-centre/agree-ii-as-a-practice-guideline-development-framework/ (30.4.18) 3. http://www.cebm.net/index.aspx?o=5653 (30.4.18).
Clinical trial identification
Legal entity responsible for the study
Australian Gastrointestinal Trials Group.
Ipsen Pty Ltd.
E. Segelov: Attendeded Advisory board: Ipsen Global. Ipsen funds CommNETS through an unrestricted grant to AGITG. This work was carried out by CommNETS. There was no involvement of Ipsen in any aspect of this research. All other authors have declared no conflicts of interest.