NANETS Statement on the Investigation of Angiogenesis Inhibitors

in Patients with Neuroendocrine Tumors

             The North American Neuroendocrine Tumor Society (NANETS) has become aware of concerns among neuroendocrine tumor patients regarding treatment with angiogenesis inhibitors. These concerns appear to be based in part on recent studies in animal models, which have raised questions about the potential for angiogenesis inhibitors to increase tumor metastases. NANETS notes that the clinical implications of these observations remain uncertain. Similar observations have not been made in humans. Moreover, extensive experience with angiogenesis inhibitors in other malignancies have shown that these agents have the ability to slow tumor growth and improve survival in patients with several different types of metastatic cancer.

              Angiogenesis inhibitors include the drugs bevacizumab (Avastin), sunitinib (Sutent), sorafenib (Nexavar) and related agents. These drugs have been used in thousands of cancer patients. Treatment with bevacizumab is known to improve survival in patients with metastatic colorectal cancer and is approved by the FDA for this indication. Treatment with bevacizumab has been further shown to slow tumor progression in patients with advanced breast cancer. Treatment with sunitinib or sorafenib improves survival in patients with kidney cancer.

             Early studies also suggest that angiogenesis inhibitors may have antitumor activity in neuroendocrine tumors. Based on these initial studies, several randomized studies are now being performed with angiogenesis inhibitors in neuroendocrine tumor patients to confirm their activity in this setting. NANETS strongly endorses these studies for patients with neuroendocrine tumors.

Signing Physicians:

Larry Kvols, MD
Chair, NANETS
Moffitt CancerCenter
Tampa, FL

William Maples, MD
Vice Chair, NANETS
Mayo Clinic
Jacksonville, FL

M. Sue O’Dorisio, MD, PhD
Treasurer, NANETS
University of Iowa
Iowa City, IA

Matthew Kulke, MD
Education Co-Coordinator, NANETS
Dana-Farber Cancer Institute
Boston, MA

Rodney Pommier, MD
Education Co-Coordinator, NANETS
NANETS Board of Directors
Oregon Health & ScienceUniversity
Portland, OR

Stephen Marx, MD
Research Co-Coordinator, NANETS
NANETS Board of Directors
NIH/National Institute of Diabetes
& Digestive & Kidney Disease
Bethesda, MD

James Yao, MD
Research Co-Coordinator, NANETS
MD AndersonCancerCenter
Houston, TX

Lowell Anthony, MD
NANETS Board of Directors
Louisiana State University
Health & Sciences Center
New Orleans, LA

Philip Boudreaux, MD
Louisiana StateUniversity
Health & Sciences Center
New Orleans, LA

Domenico Coppola, MD
Moffitt CancerCenter
Tampa, FL

Vay Liang W. Go, MD
NANETS Board of Directors
David GeffenSchool of Medicine – UCLA
Los Angeles, CA

Stanley Goldsmith, MD
NANETS Board of Directors
New York PresbyterianHospital
Weill CornellMedicalCenter
New York, NY

Aaron Vinik, MD, PhD
NANETS Board of Directors
Strelitz Diabetes Institute
Eastern VirginiaMedicalSchool
Norfolk, VA

Richard Warner, MD
NANETS Board of Directors
Mt. SinaiSchool of Medicine
New York, NY

Gregory Wiseman, MD
Mayo Clinic
Rochester, MN