A Transition in the Neuroendocrine Tumor Program at Penn Medicine

The renowned Neuroendocrine Tumor Program, which has been identified with Penn Gastroenterology for almost two decades, has recently transitioned to live under the Abramson Cancer Center as the Penn Neuroendocrine Cancer Program. This development marks both a new beginning for the Program under the direction of oncologist Jennifer Eads, MD, and the departure (to retirement) of David Metz, MD, one of the nation's leading specialists in the field of neuroendocrine disease.

David Metz, MD, A Retrospective

Arriving at Penn Medicine in 1993, David Metz, MD, held a variety of leadership roles within the Department of Gastroenterology, including Co-Directorship of the Neuroendocrine Tumor Center and Penn NET Treatment Program. Dr. Metz was previously a staff fellow at the National Institutes of Health, where he performed basic research in pancreatic acinar cell secretion and clinical research in Zollinger-Ellison syndrome. While at Penn Medicine, he served as Chair of the North American Neuroendocrine Tumor Society (NANETS), as a member of the Liaison Committee for Recertification of the American Board of Internal Medicine (American Gastroenterological Association representative), and on the Food and Drug Administration Gastrointestinal Drugs Advisory Committee, among other positions.

Dr. Metz's clinical interests at Penn included Zollinger-Ellison syndrome and other acid-peptic conditions, Helicobacter pylori infection, non-steroidal anti-inflammatory drug gastropathy and the diagnosis and management of patients with functional and non-functional neuroendocrine tumors of the pancreas and alimentary tract. An investigator for a series of prominent clinical trials in all of these areas, Dr. Metz has published more than 200 articles on topics of clinical interest and research. He retired in July 2021 after 28 years at Penn Medicine.

A New Vision for Neuroendocrine Disease at Penn Medicine

In July 2021, the former Penn NETs Treatment Center will transition to the Abramson Cancer Center as the Penn Neuroendocrine Cancer Program under the direction of Jennifer R. Eads, MD. A medical oncologist, Dr. Eads specializes in the management of patients with gastrointestinal malignancies, specifically esophageal and gastric cancer as well as neuroendocrine tumors. Dr. Eads is a clinical researcher and serves as the Principal Investigator on several clinical trials treating gastrointestinal malignancies, including esophageal cancer, gastric cancer, colorectal cancer, and multiple types of neuroendocrine tumors. Asked about the mission of the NET Cancer Program, Dr. Eads reflected on the needs of the NETs community, and the new vision for care at Penn.

"At Penn over many years, great efforts have gone into building a strong multidisciplinary team of neuroendocrine specialists and we've worked hard as well to engage physicians in the region, patients, caregivers and donors. Neuroendocrine tumors encompass such a wide variety of diseases and every patient has a unique treatment course. We fully recognize that every patient needs to be considered as an individual and that no algorithm fits all patients. We also recognize that new treatment options are much in need and have made it a focus of the program to try and broaden our clinical trial portfolio in this area."

A medical oncologist, Dr. Eads specializes in the treatment of patients with esophageal and gastric cancers as well as neuroendocrine tumors. Dr. Eads has served on the Neuroendocrine guidelines panel for the National Comprehensive Cancer Network (NCCN) and is involved with the Eastern Cooperative Oncology Group (ECOG) GI committee where she serves as the working group leader for neuroendocrine tumors. She also serves on the board of directors for the North American Neuroendocrine Tumor Society (NANETS).

In 2014, Dr. Eads was the recipient of a NANETS young investigator grant (she is now on the organization's board of directors), and she has had significant involvement in neuroendocrine research (including Phase 1-3 clinical studies at a local and national level) and education through the Eastern Cooperative Oncology Group, the National Cancer Institute, and other national level organizations. With Dr Metz, she is the author of two recent reports on peptide receptor radionuclide therapy in neuroendocrine disease based on their experience with this treatment at Penn.

A Transition in Place, A Continuum of Care

The Penn NETS Treatment Center was initiated more than a decade ago under the direction of Dr. Metz and Debbie Cohen, MD, of Penn Nephrology, and was the only program of its kind to offer a unified program for the treatment of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and pheochromocytomas/paragangliomas (PHEOs/PARAs) at an academic medical center.

The Neuroendocrine Cancer Program will continue to include PHEOs and PARAs, and Dr. Cohen will continue to champion this aspect of the program. A number of other vital therapeutic entities will be allied with the Program, including cancer genetics, nuclear medicine, interventional radiology, endocrinology, endocrine and oncologic surgery, and radiation oncology, among others. The integration with these programs will better serve the immediate needs of NET patients and the NET community.

A NET Benefit: The Future of Neuroendocrine Disease Management at Penn

In the spirit of continuity, much about the administration of the new NET Cancer Program will echo that of the former NET Center. Bonita (Bonnie) Bennett, RN, will remain as NET Program Coordinator, as will Diann Boyd, BSN, RN, OCN, as NET Nurse Navigator. Every effort has been made to ensure a seamless transition for patients from the GI Division, many of whom will continue to see the same providers. Because some aspects of neuroendocrine care may only be provided by a gastroenterologist, some patients will continue to be treated within the GI Division. Patients with metastatic disease will be transitioned to oncology providers.

Clinical Trials: Patients within the NET Cancer Program may find it easier to be involved in clinical trials. While most treatment trials are housed in medical oncology, some will occur in interventional radiology and nuclear medicine as well. A great benefit of the Program's collaborative interdisciplinary Neuroendocrine Tumor Board is that patients who are appropriate candidates for ongoing clinical trials can be captured early. Moreover, being followed in the oncology clinic places patients in close touch with physicians who might ultimately place them on a trial.

Weekly tumor-board review: As part of the Abramson Cancer Center the NET Cancer Program will now host weekly tumor-boards with the multi-disciplinary team across the health system. Patient Support Services: The annual patient conference and virtual support group will continue to provide resources and support for patients and caregivers.

A Center of Excellence: In 2021, the Penn NETS Program was designated a Center of Excellence from the PHEO PARA Alliance.

Questions & Referrals

NETs patients with questions about the new NET Cancer Program or the transition process are welcome to contact Bonnie Bennett or Diann Boyd by phone or email:

Bonita (Bonnie) Bennett, RN
Specialty: PHEOs/PARAs
215-349-8222
Bonita.Bennett@pennmedicine.upenn.edu

Diann Boyd, BSN, RN, OCN
Specialty: GEP-NETS
215-439-8281
Diann.Boyd@pennmedicine.upenn.edu

About Neuroendocrine Disease

Neuroendocrine disease is a disorder that manifests as benign or cancerous tumors originating in cells of the neuroendocrine system. Neuroendocrine tumors (or NETs) are identified with great heterogeneity, and are distinguished by their functional capacity (functional NETs produce hormones and amines sufficient to elicit symptomatic syndromes) and their differentiation. Arising as primary or metastatic lesions in many soft-tissue organ systems, NETs are now the second most prevalent cancer of the GI tract. The incidence of neuroendocrine disease has increased by six-fold in the last four decades.

Given their origins, the NETs are identified with a host of unusual complications and idiosyncrasies, and for this reason, and all of the aforementioned properties, their diagnosis and treatment is often a matter of clinical experience and expertise.

The diagnostic process for neuroendocrine disease is one marked by great individuality of presentation, and a diagnostic delay of five to seven years, on average. Among functional NETS, this lapse is the result of a host of nonspecific symptoms that mimic other diseases (collectively termed the carcinoid syndrome) prompting misdiagnosis; non-functional NETS, by contrast, can be clinically silent for years, only becoming evident when they metastasize.

More information about NETS, their origin, diagnosis and treatment, is available from the Abramson Cancer Center's page on neuroendocrine tumors.