One group of participants will receive a combination of medications, including irinotecan, fluorouracil, calcium folinate, zimberelimab, and domvanalimab. These medications are administered through IV infusion, which means they are delivered directly into a vein. Another group will receive a treatment consisting of irinotecan, fluorouracil, and calcium folinate. This study will monitor how long participants live and how the cancer responds to these different drug combinations over time.

The purpose of this study is to develop new ways to predict how long patients with neuroendocrine neoplasms might remain stable without their disease getting worse. This will be done by analyzing measurements from combined scans using both imaging substances. During the study, participants will receive both types of imaging solutions and undergo PET/CT scanning.

Both imaging substances are given as single injections into a vein. 64Cu-DOTATATE attaches to specific receptors found on neuroendocrine tumors, while 18F-FDG helps show how active the tumor cells are. The combination of these two different types of scans provides doctors with more complete information about the tumor’s characteristics and behavior.

The purpose of this study is to determine whether it is possible to perform both imaging methods at the same time to better understand how tumors use energy. During the study, participants will receive two different injectable substances: hyperpolarized [1-13C]pyruvate and Fluor-18-FDG. Both substances will be given through an intravenous injection, and then special images will be taken using a combined PET/MR scanner.

This research will help doctors better understand how tumors process different nutrients and may lead to improved ways of detecting and monitoring cancer. The imaging procedure will be performed once for each participant, and the total dose of each substance has been carefully calculated to ensure safety.

The treatment being tested is called AdVince (also known as ELC-100), which is a modified virus solution that is injected directly into the liver’s artery. This medication is a specially engineered version of a human virus that has been modified to target tumor cells. The main purpose of this research is to determine if repeated injections of AdVince into the liver artery are safe for patients with NENs that have spread to other parts of the body.

The study involves giving participants injections of AdVince through the liver artery. During the treatment, doctors will monitor patients’ health through blood tests and various imaging techniques including CT scans, MRI, and PET scans. They will also track how the body responds to the treatment by measuring substances in the blood that can indicate tumor activity. The treatment period lasts up to 7 days, and patients will be monitored for any side effects.

During the study, patients will receive a combination of carboplatin and etoposide along with durvalumab for four treatment cycles. After these initial cycles, patients will continue receiving only durvalumab as maintenance therapy. All medications will be given through intravenous (into the vein) infusions. Durvalumab is a type of medication called a monoclonal antibody that helps the immune system fight cancer cells, while carboplatin and etoposide are traditional chemotherapy medications that work by directly attacking cancer cells.

The study will measure how well patients respond to the treatment by tracking their survival time and checking if their cancer shrinks or stops growing. Doctors will monitor patients throughout the study to check for any side effects from the treatment. Regular medical examinations and imaging tests will be performed to evaluate how the treatment is working.