Questions and Answers –

Morning Session

DX of NETs – 1cm mass was not biopsied – treated with Sando – the mass went away – could it be the Sando – maybe but it could have been something else as well.  Imaging must be done properly –

Can SANDO mask marker level (CgA, Gastrin, and others) – markers can go down as much of 50%

After surgery – how do you know if you need additional treatment – very little data on adjuvant (additional therapy) after getting surgical resection – more studies need to be done –

Anti Oxidant – Goes after free radicals – discontinue during active treatment

Foods that need to be avoided on the 5HIAA test – should be avoided in general ? – maybe – no clear evidence

What happens when you only treat one lobe with SirSpheres  - can it change the other lobe prognosis – it might change the direction – i.e. the other lobe might grow faster

Generic Cancer Drug shortages – Can that happen to NETs drug – Octreotide generic can have some shortages due to some manufacturing issues.

Dose the disease decrease Vitamins D,E,A,K – Only supplement with Dr. care

How do you find the correct diet – Google a particular diet – use only big hospital sites.

Inter Arterial chemo -> Dr O’do mentioned that in Germany PRRT was being done inter arterial which may be more directed than using chemo via inter arterial method

Afternoon Session

Can Typical Lung Carcinoid change to Atypical ?  -> No

After cycle of PRRT treatment do you need more? – once you progress you need to look at it all over again

PRRT – is it a last resort?  In the US it is – perhaps once it is approved in US the new standard of care might be – surgery first PRRNT second – (o’do)

Do you stay on LAR after PRRT ? O’do answer Yes -> DelPassand – Can stop is symptoms stop

If you have resectable tumors – should you do PRRT first or surgery – Surgery first if possible

Interfureon does it work – there are studies on this – but it is a challenging drug to take

Goal 1 is stability – try to make this a chronic disease

Food to consume for NETs – High in protein food – egg whites and fish.  Eggs are high in protein – you are at risk for other disease – need to reduce your risk for other disease – back off fruit juice – try the fruit.  Try putting mushrooms in the window and have them absorb the light for VIT D.  Try cooked veg – as they are easier to digest

How do you reduce protein loss – increase carbohydrate – use your muscle

Why transplant held as last resort – you are trading one challenge for another – transplant is life limiting

Affinitor – mTOR inhibitor – has a measurable results – but not one of Dr Gerstein favorites – it is very hard to tolerate.

End of Session