Episode #55
Episode 55: NEN Treatment Sequencing & Strategy
In this episode, medical oncologist Dr. Chandrikha Chandrasekharan from MD Anderson Cancer Center breaks down how treatment decisions are made and sequenced for patients with neuroendocrine neoplasms (NENs). The conversation explores what “benign” and “indolent” really mean, how treatment goals are defined, and how clinicians balance effectiveness, side effects, and long-term strategy. Dr. Chandrasekharan discusses sequencing therapies without burning bridges, when treatments can be reused, how prior response informs future decisions, and when to consider clinical trials. The episode emphasizes shared decision-making, aligning treatment plans with patient values, and navigating care with clarity rather than fear. TOP TEN QUESTIONS 1. Is Neuroendocrine Cancer ever “benign”? What does “benign” actually mean in the context of neuroendocrine tumors? When might a tumor be considered benign, and when is it clearly malignant? Can neuroendocrine cancer be “cured”? How should patients understand tumor behavior if they’ve been told theirs is slow-growing or “indolent”? 2. What is the real goal of treatment? Can I go into “remission”? Is it to make all the tumors disappear? Many patients describe feeling like they have a ticking time bomb inside them. Can you speak to that fear and how treatment goals are set? 3. Which treatment works “the best”? How do we even define “best” when it comes to neuroendocrine cancer? 4. Which treatments tend to have the fewest side effects? How should patients think about balancing effectiveness with quality of life? 5. How can someone know which treatment is right for their type of neuroendocrine cancer and their current situation? What factors matter most? 6. Is there a “best way” to sequence treatments? How do patients and clinicians prioritize options in a way that doesn’t “burn bridges” for the future? How do age, gender, race, and ethnicity influence treatment decisions, if at all? 7. If a treatment worked well for me before, is it possible to use it again? If a treatment does not work well, what does that mean? Does it predict how I might respond to another therapy? Does it imply anything about my overall prognosis? 8. What are the “big guns,” and when should they be used? Is there such a thing as “wasting” a treatment? 9. When should someone consider clinical trials? Should clinical trials be considered only after standard treatments, or earlier? 10. What advice do you have for people who receive differing opinions from their provider(s)? Bonus: What advice do you have for patients in communicating their values and preferences with their providers? ABOUT THE SPEAKER Dr. Chandrikha Chandrasekharan is a Clinical Associate Professor at MD Anderson Cancer Center, where she has focused on neuroendocrine tumors and pancreatic cancer since January 2025. She is a dual board-certified physician in Medical Oncology and Palliative Medicine. Dr. Chandrasekharan earned her medical degree from Kilpauk Medical College in India. She completed her internal medicine residency at the University of Florida College of Medicine in Jacksonville, followed by a fellowship in Palliative Medicine at Mayo Clinic, Rochester. She then pursued a fellowship in Medical Oncology at LSU Shreveport, and further specialized in gastrointestinal malignancies with an additional year of training at Mayo Clinic, where she developed a strong interest in neuroendocrine tumors. Prior to joining MD Anderson, Dr. Chandrasekharan served for eight years as a Clinical Associate Professor at the University of Iowa. There, she co-led the gastrointestinal oncology program and treated a broad range of GI malignancies. From 2021 to 2022, she was Co-Director of the Clinical Core for the Neuroendocrine Tumor SPORE. She is an active member of the North American Neuroendocrine Tumor Society (NANETS), currently serving as Co-Chair of the NANETS Annual Symposium Planning Committee, and previously chaired the Regional Medical Education Committee. In addition to her clinical and academic work, Dr. Chandrasekharan is engaged in clinical trials and research focused on healthcare outcomes, health equity, and global oncology care. Visit https://www.ncf.net/podcast/55 for more resources. For more information, visit NCF.net .
