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Gastroenteropancreatic Neuroendocrine Tumor Vignettes: Can You Manage These Patients Effectively?

  • Authors: Jonathan Strosberg, MD
  • CME / ABIM MOC Released: 6/27/2022
  • Valid for credit through: 6/27/2023
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for oncologists, gastroenterologists, surgeons, pathologists, endocrinologists, radiologists, and other healthcare providers on the multidisciplinary care team.

The goal of this activity is to help learners as members of the multidisciplinary team more effectively diagnose and manage patients with GEP-NETs.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Clinical trial data evaluating treatment options for patients with GEP-NETs
    • Characteristics that guide treatment selection for patients with GEP-NETs
  • Have greater competence related to
    • Creating a personalized care plan for patients with GEP-NETs
    • Mitigating treatment-related adverse events in patients receiving therapy for GEP-NETs
  • Demonstrate greater confidence in their ability to
    • Work as members of the multidisciplinary care team to optimize the care of patients with GEP-NETs


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  • Jonathan Strosberg, MD

    Section Head, Neuroendocrine Oncology
    Moffitt Cancer Center
    Tampa, Florida, United States


    Jonathan Strosberg, MD, has the following relevant financial relationships:
    Consultant or advisor for: Tersera
    Speaker or member of speakers bureau for: Ipsen
    Research funding from: ITM; Merck; Novartis


  • Charlotte Warren

    Senior Director, Content Development, Medscape, LLC 


    Charlotte Warren has no relevant financial relationships.

  • Jason Luis Quiñones, PhD

    Scientific Content Manager, Medscape, LLC 


    Jason Luis Quiñones, PhD, has no relevant financial relationships.

  • Tristin Abair, PhD

    Senior Medical Writer, WebMD Global, LLC 


    Tristin Abair, PhD, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

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There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

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Gastroenteropancreatic Neuroendocrine Tumor Vignettes: Can You Manage These Patients Effectively?

Authors: Jonathan Strosberg, MDFaculty and Disclosures

CME / ABIM MOC Released: 6/27/2022

Valid for credit through: 6/27/2023



  1. Pavel M, et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31:844-860.
  2. Wang, R, et al. Management of gastrointestinal neuroendocrine tumors. Clin Med Insights Endocrinol Diabetes. 2019;12:1179551419884058.
  3. Cives M, et al. Gastroenteropancreatic neuroendocrine tumors. CA Cancer J Clin. 2018;68:471-487.
  4. National Comprehensive Cancer Network (NCCN). Neuroendocrine and adrenal tumors (Version 1.2022). 2022. Accessed May 24, 2022.
  5. Kunz PL, et al. Consensus guidelines for the management and treatment of neuroendocrine tumors. Pancrease. 2013;42:557-577.
  6. Davar J, et al. Diagnosing and managing carcinoid heart disease in patients with neuroendocrine tumors: an expert statement. J Am Coll Cardiol. 2017;69:1288-1304.
  7. Octreotide [prescribing information]. Approved 1988. Revised March 2021.
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  9. Rinke A, et al; PROMID Study Group. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol. 2009;27:4656-4663.
  10. Caplin ME, et al; CLARINET Investigators. Lanreotide in metastatic enteropancreatic neuroendocrine tumors. N Engl J Med. 2014;371:224-233.
  11. Cuyle PJ, et al. Practical management of toxicities associated with targeted therapies for advanced gastroenteropancreatic neuroendocrine tumors. Ann Gastroenterol. 2018;31:140-150.
  12. Pusceddu S, et al. Differential diagnosis and management of diarrhea in patients with neuroendocrine tumors. J Clin Med. 2020;9:2468.
  13. Saif MW, et al. Chronic use of long-acting somatostatin analogues (SSAs) and exocrine pancreatic insufficiency (EPI) in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs): an under-recognized adverse effect. Cancer Med J. 2020;3:75-84.
  14. Panzuto F, et al. Exocrine pancreatic insufficiency and somatostatin analogs in patients with neuroendocrine neoplasia. Expert Opin Drug Saf. 2021;20:383-386.
  15. Klimstra DS, et al. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas. 2010;39:707-712.
  16. Dasari A, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the united states. JAMA Oncol. 2017;3:1335-1342.
  17. Van Riet J, et al. The genomic landscape of 85 advanced neuroendocrine neoplasms reveals subtype-heterogeneity and potential therapeutic targets. Nat Comm. 2021;12:1-14.
  18. Prisciandaro M, et al. Biomarker landscape in neuroendocrine tumors with high-grade features: current knowledge and future perspective. Front Oncol. 2022;12:1-13.
  19. Kunz PL, et al. A randomized study of temozolomide or temozolomide and capecitabine in patients with advanced pancreatic neuroendocrine tumors: a trial of the ECOG-ACRIN Cancer Research Group (E2211). J Clin Oncol. 2018;36(15 suppl):4004.
  20. Strosberg J, et al. Using capecitabine/temozolomide or 177Lu-Dotatate to treat NETs requires real-world guide. Targeted Oncology. Published February 1, 2022. Accessed June 21, 2022.
  21. Temozolomide [prescribing information]. Approved 1999. Revised November 2019.
  22. Lutetium Lu 177 dotatate [prescribing information]. Approved 2018. Revised May 2020.
  23. Yao JC, et al. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. Lancet. 2016; 387: 968-977.
  24. Raymond E et al. Sunitinib Malate for the Treatment of Pancreatic Neuroendocrine Tumors. N Engl J Med. 2011; 364: 501-513.
  25. Strosberg J, et al. NETTER-1 Trial Investigators. Phase 3 trial of 177Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376:125-135.
  26. Brabander T, et al. Long-term efficacy, survival, and safety of [177Lu-DOTA0,Tyr3]octreotate in patients with gastroenteropancreatic and bronchial neuroendocrine tumors.
  27. Strosberg J, et al. Risk of bowel obstruction in patients with mesenteric or peritoneal disease receiving peptide receptor radionucleotide therapy. J Nucl Med. 2021;62:69-72.
  28. Hope TA, et al. NANETS/SNMMI procedure standard for somatostatin receptor-based peptide receptor radionuclide therapy with 177Lu-DOTATATE. J Nucl Med. 2019;60:937-943.
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