In G1 metastatic GEP-NET with small lesions visible on PET dotatate, very low burden of disease on CT and no clinical symptoms, are there any data to suggest early lanreotide changes natural history of disease and prolongs OS vs observation until symptoms?

The answer is no, there is no such data supporting an early intervention. The keywords here are "no clinical symptoms". For patients with functional panc NETs or siNETs with carcinoid syndrome, initiation of somatostatin analog (SSA) therapy is indicated for syndrome control.

The NCCN, ENETS, and NANETS guidelines all list observation as an appropriate option, and indeed, I have been observing a patient with very slowly progressive peritoneal mets since 2016.

The strongest evidence for this approa...