James Howe

[James Howe @JamesHoweV]

@AnnSurgOncol Many will do the same as we do, but others may just go straight to PRRT without surgical cytoreduction. That is why it is very important to have multidisciplinary care for NET patients and that surgeons weigh in. Neoadjuvant PRRT is not commonly used in the USA.

[James Howe @JamesHoweV]

@lgeisel18 @AnnSurgOncol We included patients between 1999-2022, so many but not all had long term follow-up. However, loss of significance may have been due more to the stringency of using time dependent covariate analysis, which credits all survival to the No PRRT group until PRRT is received.

[James Howe @JamesHoweV]

@DrSabha @AnnSurgOncol Many studies do not factor this in. Patients that live long enough to get the treatment do better by definition, because those who die before that go into the "other tx" group

[James Howe @JamesHoweV]

@DrSabha @AnnSurgOncol Yes, that is our strategy

[James Howe @JamesHoweV]

@DrSabha @AnnSurgOncol Yes. Remove the disease first (if possible) then do PRRT in those cases.

[James Howe @JamesHoweV]

@MikeWach_MD @AnnSurgOncol Peritoneal mets treated with PRRT can cause a local reaction leading to obstruction, as reported by Jon Strosberg in F/U of NETTER1

[James Howe @JamesHoweV]

@MikeWach_MD @AnnSurgOncol We thought PRRT would be a good answer for peritoneal mets, but it can often cause problems. The lesions get inflamed causing a local reaction, possibly sticking to the adjacent bowel. Jon Strosberg found obstruction to be an issue in some of these patients in NETTER1 follow-up.

[James Howe @JamesHoweV]

@DrSabha @AnnSurgOncol We always tried to get the most disease as we could safely. If we could not get at least 70%, we did not try. From previous studies this means that nearly 2/3 of patients with metastatic disease were eligible for cytoreduction.

[James Howe @JamesHoweV]

@SchultzKurt @AnnSurgOncol Because both groups were probably pretty evenly matched, both having a lot of disease. PFS after Cytoreduction was the same. This was before they got either PRRT or other therapies.

[James Howe @JamesHoweV]

@OncoThor @AnnSurgOncol The elephant in the room is nephrotoxicity. We have seen several patients develop severe CKD, but these data are not yet available from the alpha trials

[James Howe @JamesHoweV]

@AnnSurgOncol @OncoThor The elephant in the room is nephrotoxicity. We have had several patients develop severe CKD, but these data have not yet been reported from the trial