186P - Characterization of the gastroenteropancreatic neuroendocrine tumour patient journey

Background

With increasing incidence and prevalence of gastroenteropancreatic neuroendocrine tumours (GEP-NETs), there is a need to identify inefficiencies in patient management.

Methods

To provide a view of the journey for patients with GEP-NETs, healthcare professionals (HCPs) and patients from the USA and EU4 (France, Italy, Spain, UK) were interviewed with responses analyzed to determine consensus views.

Results

Fifty-four interviews were completed (49 HCPs, five patients). Time to first diagnosis of GEP-NET takes 5–7 years on average and misdiagnosis is common. Multidisciplinary team (MDT) structure and dynamics vary by practice type, institution, and country. In academic settings, GEP-NET is discussed in gastroenterology and/or hepatobiliary tumour boards, but centres with large case volume may hold NET-specific MDTs. Nuclear medicine physicians are increasingly involved in MDTs across many institutions, where they are consulted on patient eligibility for peptide receptor radionuclide therapy (PRRT). In the USA, medical oncologists are the primary treatment decision-makers, while gastroenterologists and endocrinologists are more involved in decisions in Europe, depending on tumour localization. Surgery-ineligible first-line cases are widely managed with somatostatin analogue therapy, and systemic options including PRRT and liver-directed therapies are provided for patients with metastatic disease. While PRRT is commonly used in second-line for low grade, well differentiated tumors, it can be considered in first-line for patients with poorly differentiated fast-growing, somatostatin receptor-positive tumours. Treatment sequencing depends highly on physician attitudes and logistical barriers. HCP follow-up varies according to treatment and experience with GEP-NET.

Conclusions

The rarity of GEP-NET, along with its late diagnosis and misdiagnosis can lead to complexities and uncertainty in sequencing when selecting the right therapy. Differences in management decision vary amongst institutions and countries, and the involvement of nuclear medicine physicians in the decision-making process of MDTs can improve awareness to availability of a treatment option such as PRRT.

Clinical trial identification

Editorial acknowledgement

Under the guidance of the authors, Dr Martin Guppy from Oxford PharmaGenesis provided medical writing support for this abstract, with funding from Advanced Accelerator Applications, a Novartis Company.

Legal entity responsible for the study

Advanced Accelerator Applications SA, a Novartis Company.

Funding

Advanced Accelerator Applications SA, a Novartis Company.

Disclosure

G.A. Fisher Jr: Honoraria (self): Advanced Accelerator Applications; Honoraria (self): Ipsen; Research grant/Funding (self): Genentech/Roche; Research grant/Funding (self): Aduro; Research grant/Funding (self): Xencor; Research grant/Funding (self): FortySeven; Advisory/Consultancy: Merck; Advisory/Consultancy: Taiho; Advisory/Consultancy: Pfizer; Officer/Board of Directors, Data Safety Monitoring Board: AstraZeneca; Officer/Board of Directors, Data Safety Monitoring Board: Hutchison MediPharma International. V. Nassiri: Full/Part-time employment: Advanced Accelerator Applications, a Novartis company; Shareholder/Stockholder/Stock options: Novartis. F. Erman: Full/Part-time employment: Advanced Accelerator Applications; a Novartis Company. S. Mutevelic: Full/Part-time employment: Advanced Accelerator Applications; a Novartis Company; Shareholder/Stockholder/Stock options: Novartis.