Selecting the Next Line of Therapy After SSA and PRRT in Progressive Pancreatic Neuroendocrine Tumor

This section focuses on the clinical decision making process following progression on lanreotide and lutetium Lu 177 dotatate. Dr Shaheen outlines how she approaches next line therapy selection in a patient who has already received two established treatments for SSTR positive pancreatic NETs.

She begins by emphasizing that progression after PRRT represents a meaningful inflection point. While PRRT can offer durable disease control, eventual progression requires reassessment of both disease tempo and therapeutic goals. Dr Shaheen notes that at this stage, the objective is not only tumor control but also preservation of quality of life, given the patient remains active and engaged in daily activities.

The discussion highlights the importance of reviewing prior treatment tolerance and duration of benefit. An eighteen month period of stable disease following PRRT suggests sensitivity to systemic therapy and supports continued intervention rather than observation alone. Dr Shaheen explains that she considers both targeted therapies and cytotoxic options, tailoring selection to disease burden, pace of progression, and patient preference.

She also addresses the role of symptom management and avoidance of unnecessary toxicity. Given the absence of rapid clinical decline, she favors approaches that offer disease control without compromising functional status.

This segment underscores that post PRRT therapy selection is rarely algorithmic. Instead, it requires synthesis of prior response, current disease behavior, and patient specific considerations. Dr Shaheen presents this decision as a thoughtful transition rather than a reactive step, reinforcing the value of individualized care in pancreatic NET management.