Unmet Needs and Emerging Mechanisms of Action in Extrapulmonary Neuroendocrine Carcinoma: The Path Toward Better Therapies

In ‘Unmet Needs and Emerging Mechanisms of Action in Extrapulmonary Neuroendocrine Carcinoma: The Path Toward Better Therapies,’ the expert oncologists examined the following critical questions:

What are the unmet needs with current therapies in neuroendocrine carcinomas that have led to the development of newer therapies?

What are the different mechanisms of action that are currently under investigation for neuroendocrine carcinomas?

Led by the moderator, the panelists discussed the significant unmet needs that persist with current standard-of-care platinum-based chemotherapy for extrapulmonary neuroendocrine carcinoma (epNEC), noting that while response rates can reach 50 to 60%, responses are short-lived as tumors rapidly develop resistance, and the toxic nature of treatment places a heavy burden on patients who may not have the opportunity to receive subsequent lines of therapy. Namrata Vijayvergia, Sandy Kotiah, William Oh, and Aman Chauhan highlighted the limitations of a one-size-fits-all chemotherapy approach that was borrowed from the small cell lung cancer space and has not been tailored to the unique biology of epNEC arising from different primary sites. The panelists then explored the exciting landscape of novel mechanisms under investigation, including T-cell engaging bispecific antibodies, antibody-drug conjugates (ADCs), chimeric antigen receptor T-cell (CAR-T) therapy, and radiopharmaceutical approaches, many of which target delta-like ligand 3 (DLL3), which is expressed in 70 to 80% of epNEC cases. They emphasized that this multiplatform approach to drug development represents a pivotal moment for the field and offers real hope for transforming epNEC from an acutely fatal disease into one that can be managed more effectively over time.

Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

Our next episode, ‘Emerging Data and the Future Treatment Landscape in Extrapulmonary Neuroendocrine Carcinoma: Novel Therapies, Algorithms, and Combination Strategies,’ further explores extrapulmonary neuroendocrine carcinoma, highlighting the most exciting emerging clinical data, where novel therapies are expected to fit into treatment algorithms, and the growing role of combination therapy in improving patient outcomes.