When neuroendocrine tumors (NETs) continue growing after treatment, patients and caregivers often face difficult questions about what comes next. Fortunately, ongoing research continues to expand the number of treatment options available for people living with NETs.
One of the most important recent advances comes from the CABINET clinical trial, which studied a targeted therapy called cabozantinib in patients with advanced neuroendocrine tumors whose disease had progressed despite previous treatment.
The results have generated significant interest within the NET community because they demonstrate meaningful disease control across multiple NET subtypes, including both pancreatic and non-pancreatic tumors.
What Is Cabozantinib?
Unlike traditional chemotherapy, cabozantinib is an oral targeted therapy, taken as a daily pill, that is designed to interfere with specific pathways cancer cells use to grow and survive.
It works by blocking several proteins involved in tumor growth and blood vessel formation. This disrupts the pathways tumors rely on to receive oxygen and nutrients, which can help slow disease progression.
Why Was the CABINET Trial Important?
Researchers designed the CABINET trial to answer an important question:
Can cabozantinib help patients whose neuroendocrine tumors continue to grow after other approved treatments?
The study included patients with:
- Pancreatic neuroendocrine tumors (pNETs)
- Gastrointestinal NETs
- Lung NETs
- NETs of unknown primary origin
Participants had already received at least one FDA-approved NET treatment before joining the study.
These results are especially encouraging because cabozantinib is approved for adults with previously treated advanced NETs regardless of where the tumor started, whether the disease is functional or nonfunctional, or whether tumors express somatostatin receptors (SSTRs) on PET imaging.
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Understanding Progression-Free Survival
One of the most important concepts in NET research is progression-free survival (PFS), which measures how long patients live before their cancer shows signs of growth on imaging scans.
While many patients naturally focus on overall survival, progression-free survival is often the primary endpoint in NET studies because slowing tumor growth can help maintain stability, preserve quality of life, and create additional opportunities for future treatment.
Many NET therapies are considered disease-controlling treatments. Their goal is often to slow or stop progression rather than eliminate every cancer cell. For many patients, extending the period of disease stability can be a meaningful outcome.
What Did the CABINET Trial Find?
Results for Non-Pancreatic NETs
Among patients with non-pancreatic NETs, cabozantinib more than doubled the time before disease progression.
- Cabozantinib: 8.4 months before progression
- Placebo: 3.9 months before progression
Researchers also observed tumor shrinkage more frequently among patients receiving cabozantinib.
Results for Pancreatic NETs
The benefits were even greater among patients with pancreatic neuroendocrine tumors.
- Cabozantinib: 13.8 months before progression
- Placebo: 4.4 months before progression
Many patients also experienced reductions in tumor size during treatment.
Why Are NET Specialists Excited About These Findings?
One of the most significant aspects of the CABINET trial is the broad range of patients who benefited from treatment.
Cabozantinib demonstrated activity:
- Across multiple NET primary sites
- Across different tumor grades included in the study
- After previous NET therapies had stopped working
- In some patients with tumors of unknown primary origin
For patients and care teams, this provides another evidence-based treatment option when disease progression occurs despite earlier therapies.
What Side Effects Were Seen?
Like all cancer therapies, cabozantinib can cause side effects. These can often be managed through monitoring, supportive care, or dosage adjustments. Many patients required dose adjustments during treatment, which highlights the importance of maintaining open communication with healthcare providers and reporting symptoms early.
The most commonly reported side effects included:
- Fatigue
- Diarrhea
- High blood pressure
- Elevated liver enzymes
What Comes Next?
As research advances, there is a growing number of treatment options designed to help control disease and improve quality of life for patients living with NETs. The CABINET trial represents an important step forward for the NET community, but research continues as scientists actively study:
- The best sequence for using NET therapies
- Optimal dosing strategies for cabozantinib
- Newer related therapies such as zanzalintinib
- Future combinations of targeted treatments
Questions to Discuss With Your Care Team
If you are living with a neuroendocrine tumor, consider asking your healthcare team:
- Is cabozantinib appropriate for my type of NET?
- What treatments are typically used before cabozantinib?
- What side effects should I monitor?
- How will treatment response be measured?
- Are there clinical trials that may be appropriate for me?
Staying Informed Through FLaNET
At FLaNET, we believe patients and caregivers deserve access to clear, trustworthy information about neuroendocrine tumor care. Whether you are newly diagnosed or exploring treatment options after progression, we are committed to helping you stay informed and make confident decisions alongside your healthcare team.
Explore our educational resources, attend upcoming webinars, and connect with the growing FLaNET community.
Stay Connected With the NET Community
The NET Light Guide is a collaborative educational resource developed by FLaNET, NCF, and AMEND USA. Follow all three organizations for the latest updates as we continue expanding these tools and educational resources for the NET community.