NETs Treatment: Standardizing Surgery and Collaboration via the CUTNETs Initiative

In an interview, Julie Hendrick-Hallet, MD, and Stefano Partelli, MD, discuss the role of collaboration for the treatment of neuroendocrine tumors (NETs).

Hendrick-Hallet and Partelli emphasize the urgent need to improve the surgical evidence base for managing NETs. Due to the uncommon nature of NETs, single-center data is insufficient, leading to the formation of the CUTNETs collaborative, a group of 27 surgical centers across North America and Europe dedicated to standardizing and enhancing care.

A primary goal of CUTNETs (Collaborative of sUrgical Teams for NeuroEndocrine Tumors) is to establish objective criteria for resectability, especially for pancreatic NETs, where there is currently little consensus. By standardizing the definition of resectable/nonresectable tumors, the collaborative can better identify high-risk patients who may benefit from systemic therapy before surgery, rather than an upfront operation.

Collaboration is deemed crucial for pooling the necessary patient numbers and expertise to generate high-quality data. This effort also aims to increase the level of education for surgeons globally, ensuring they provide the appropriate surgical indications and refer complex cases to high-volume, multidisciplinary teams.

Several key unmet needs are as follows:

1. Defining the Role of Surgery: Establishing the true long-term benefit and outcomes of surgery, including patient quality of life, given that NET patients often have long life spans.
2. Sequencing Therapy: Determining the best combination and sequence of surgery with other systemic treatments.
3. Biomarker Identification: The lack of specific biomarkers to accurately identify aggressive tumors or those with a high risk of recurrence remains a technical challenge.

Ultimately, the goal is to move the management of NETs away from subjective resectability decisions—often "in the eye of the beholder"—to a system of standardized, objective, and multidisciplinary criteria, ensuring all patients receive consistent, high-quality treatment.