In this issue of CHEST (see page 955), Fazio and colleagues14 have performed a careful analysis of the patients with advanced lung NETs (bronchial carcinoids). All participants had carcinoid syndrome (required for enrollment on the parent trial). They performed an unplanned subgroup analysis for purposes of hypothesis generation. Thirty-three enrollees (75%) had well-differentiated (G1) NETs (typical carcinoids) and nine had moderately differentiated (G2) NETs (atypical carcinoids). Two-thirds of participants on each arm had received prior somatostatin analog therapy. The median PFS for patients on everolimus plus octreotide LAR was 13.6 months compared with 5.6 months with octreotide LAR alone (hazard ratio, 0.72; 95% CI, 0.31-1.68; P =.23). Nearly one-half of the subjects treated with everolimus and octreotide LAR had grade 3 or 4 adverse events, including those that have a significant impact on quality of life (stomatitis, diarrhea, and so forth), and 60% of subjects required dose reduction of everolimus. Although this trial is not definitive, it is certainly promising and requires a larger trial to confirm or refute these observations. As the authors point out, this is a small study, but it is arguably the largest trial with systemic therapy ever conducted against lung carcinoid tumors. The follow-up study is already planned but not yet launched. It is named the Neuroendocrine Carcinoma of Lung and Thymus (LUNA) trial.15 In this study, participants with NETs from the lung or thymus will be randomized to receive treatment with the somatostatin analog pasireotide LAR IM every 28 days or everolimus 10 mg orally/d or the combination. Patients with severe functional disease requiring treatment with somatostatin analogs are excluded from the trial. The estimated accrual is 112 patients, and the primary outcome will be the proportion of patients with PFS at 12 months.