How would you approach adjuvant therapy for a patient with resected T4N1 high grade large cell neuroendocrine tumor of the cecum with adenocarcinoma component?  

Pathology details: 75% high grade large cell neuroendocrine tumor of the cecum (20-30 mitoses per 10 hpf, Ki67 75%) and 25% adenocarcinoma. Patient has V600E mutation and is also MSI-H (loss of MLH1, PMS2).  Stage pT4N1M0 (neuroendocrine staging).



Answer from: Medical Oncologist at Community Practice