The net grade 3 is a diagnosis that has only been made in recent years. And what they saw is that for patients with well-differentiated tumors, they’re usually grade 1 or grade 2 with a Ki67 less than 20%. Those patients tend to do better. Their survival is usually better. They’re a slightly slower growing tumor. However, patients with a Ki67 greater than 20%, the tumors are more fast-growing...
The net grade 3 is a diagnosis that has only been made in recent years. And what they saw is that for patients with well-differentiated tumors, they’re usually grade 1 or grade 2 with a Ki67 less than 20%. Those patients tend to do better. Their survival is usually better. They’re a slightly slower growing tumor. However, patients with a Ki67 greater than 20%, the tumors are more fast-growing. But then the pathologist looked at the diagnosis and the tumors under the microscope, essentially, and they saw that there was actually differences in the morphology of some of the patients who were potentially doing better. And they diagnosed a grade three neuroendocrine tumor. So those patients are potentially doing better and potentially respond differently to different types of treatment. So it’s really important that you have a pathologist who has expertise in neuroendocrine tumors reviewing the tumor samples. Because usually with the grade three well-differentiated NETs, the first-line systemic therapy option that would be recommended would be capecitabine with temozolomide. Versus if your patient is diagnosed with a poorly differentiated neuroendocrine carcinoma, extrapulmonary, platinum etoposide would be recommended. And it has been shown that actually patients potentially who would get the alternative, i.e. the platinum etoposide rather than capecitabine up front, may not do as well. So it is very important. And also with the grade three well-differentiated NET, it’s important to do an FDG PET scan and a gallium scan. And because there may be uptake on the gallium scan and from the NETTER to study, they have shown that patients may get benefit from PRRT if they have avidity on the gallium scans. So again, another treatment option that may be available for grade three well-differentiated NETs where that treatment option is available. It’s not available in all countries, but it is a potential option, maybe a potential option for the future.
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