What second line therapy do you use for metastatic gastroenterohepatic neuroendocrine carcinoma (G3 NEC) with progression after platinum based therapy?

I completely agree that convincing evidence is lacking.

We tend to lean on 5-FU and irinotecan based regimens, based on the FFCD-GTE data and the case report-level data with FOLFIRINOX (PMID 25662891). While there are also retrospective data with TMZ-based regimens, published data are not as clear o...

In the absence of a clinical trial, I agree that FOLFIRI would be the best choice and is generally well tolerated as second line therapy. I would certainly offer tumor genotyping as NECs are generally high mutational burden malignancies which may identify drugable targets and eligibility for clinica...