Net Cancer Day Webinar

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Net Cancer Day Webinar The webinar will start shortly Please make sure to dial in using the numbers provided or in the upper right hand side of the screen select Switch to Interactive Meeting to enable audio on your computer. If you have questions you are interested in asking please send them to contactus@norcalcarcinet.org - we regret that not all will be able to be answered.

Agenda Survey results Introductions 3 Discussion Questions Questions

Patient Advocates Bill Claxton Founder of CNETS Singapore Josh Mailman President of NorCal CarciNet Community Chair of Patient Advocate Board Society of Nuclear Medicine and Molecular Imaging

Neuroendocrine Tumor Clinics Program Director: Thomas M. O Dorisio Co-Director: M. Sue O Dorisio 1500 UIOWA Institutional Review Board (IRB) Registered Subjects Six dedicated NET clinics weekly, multi-disciplined with Endo- Oncology, Endocrine Surgery, GI Medical Oncology (ALL in same clinic Pod ) 1,300 patient-visits yearly An FDA-Investigator New Drug (IND) Two Trials with Ga 68 - DOTATOC-PET (P.I. M. Sue O Dorisio Richard Baum, Consultant) An FDA-IND for large clinical trial (Phase II) with y 90 -DOTATOC PRRNT, in Children, Adolescents, and Adults

Neuroendocrine Tumor Clinic Vanderbilt University Medical Center Leaders: Eric Liu, Ronald Walker, Jeff Clanton Multidisciplinary Team (weekly meetings) Advanced Surgical, Medical, and Imaging for Neuroendocrine Collaboration with European Centers First use of 68Ga PET/CT Imaging for NET in U.S. Clinical Trials for NETs Treatment for Adults and Children

Zentralklinik Bad Berka ENETS Center of Excellence since 2011 Richard P. Baum >1200 NET patients visits/year 15 MDs involved directly in care of NET patients 500 Peptide Receptor-mediated Radionuclide Therapies (PRRT) per year THERANOSTICS Research Center (and THERANOSTICS School in statu nascendi) PET/CT Center & NM Department Molecular Radiotherapy & Imaging (PET/CT Center) specialized nuclear medicine ward, medical physcis and GMP radiopharmaceutical facilities radiopharmacy Center Int. Medicine, Endocrinology, Gastroenterology, Oncology, Abdominal, Thoracic, Spinal and Heart Surgery Radiology, Interventional Radiology Nuclear Medicine Ward (22 beds for RN treatment)

Agenda Survey results Introductions 3 Discussion Questions Questions

Question 1: Education / Knowledge Transfer All of your centers and staff have spent considerable amounts of time and travel to conferences and other educational events - (over a million miles this year alone) - Can you share with us some of the outcomes of these meetings and how they impact the nets community.

Question 2: What is Next? Where are the breakthroughs coming from for NETs - what areas and what are the drivers.

Comparison of 177 Lu-DOTATATE and 177 Lu-DOTA-JR11 dosimetry Patient with NEC (G3) of the bladder with lymphnode and uterus metastases, shows progression after surgery and treatment with Somatostatin analogues 68 Ga-DOTA-TATE PET 177 Lu-DOTA-TATE (Agonist) Isodose curves based on 3D voxel dosimetry analysis 177 Lu-DOTA-JR11 (Antagonist) Isodose curves based on 3D voxel dosimetry analysis Limited kidney function Creatinine clearence: 54 ml/ min (norm 90 179 ml/min) mean dose: 1.4 Gy/GBq Tumor-to-kidney dose ratio: 1.1 sst 2 affinity profile (IC 50 ) 0.7 ± 0.15 nm Courtesy Damian Wild mean dose: 5.7 Gy/GBq Tumor-to-kidney dose ratio: 2.5 sst 2 affinity profile (IC 50 ) 1.5 ± 0.4 nm

Question 3: When to search for more expertise From a clinicians view what factors should patients weigh when selecting a center for care - when do they need to consider traveling

ENETS Center of Excellence Structure Main Partners Nuclear Medicine Gastroenterology Endocrinology Oncology Radiology Surgery Pathology Ongoing Studies BESTTHERAP Y-NET NEO-LEBE Clinical Studies PRRT Group NET Registry Genetic Signatures Associated Partners Labory Medicine Cardiology/ Heart Surgery Pulmonology/ Thoracic Sx Palliative Medicine/ Pain Treatment University Hospital Jena Transplanatation Medicine Human Genetics

Agenda Survey results Introductions 3 Discussion Questions Questions