Systemic Therapy Selection and Guideline Based Sequencing in Progressive Small Bowel Neuroendocrine Tumor

This segment focuses on systemic treatment selection following progression on somatostatin analog therapy in progressive small bowel neuroendocrine tumor and examines how guideline recommendations are applied in everyday clinical practice. The discussion centers on peptide receptor radionuclide therapy, everolimus, and cabozantinib as commonly considered options in this setting. Dr Lieu explains that guidelines provide an important framework but must be interpreted alongside individual patient factors.

Key considerations influencing sequencing decisions include tumor burden, rate of progression, prior treatment durability, comorbidities, and patient preferences. Peptide receptor radionuclide therapy is frequently positioned early for patients with confirmed somatostatin receptor positive disease and meaningful progression, particularly when long term disease control is a priority. Targeted oral therapies are discussed as appropriate alternatives or subsequent options depending on clinical context.

Dr Lieu emphasizes that guideline based care in progressive small bowel neuroendocrine tumor does not follow a rigid algorithm. Instead, sequencing decisions evolve as disease behavior changes and cumulative toxicity becomes relevant. Practical considerations such as treatment logistics, monitoring requirements, and access to specialized care are also addressed.

By integrating evidence based recommendations with real world experience, this segment provides a pragmatic approach to navigating systemic therapy choices. The discussion reinforces the importance of balancing consistency with flexibility while remaining aligned with best practices in the management of progressive small bowel neuroendocrine tumor.