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Using the radioactive drug lutetium dotatate as the first treatment for faster-growing neuroendocrine tumours, rather than saving it for later, nearly tripled the time without progression compared with high-dose octreotide.
Open-label phase 3 trial of 226 patients with newly diagnosed, somatostatin-receptor-positive grade 2-3 (Ki-67 10-55%) advanced gastroenteropancreatic neuroendocrine tumours randomised 2:1 to four cycles of 177Lu-dotatate plus octreotide LAR 30 mg or high-dose octreotide LAR (60 mg). Primary endpoint was PFS by blinded review.
Median PFS was 22.8 vs 8.5 months (HR 0.28) with an objective response rate of 43% vs 9%. Following NETTER-1 (which established lutetium dotatate in progressive midgut tumours), it moved radioligand therapy to the first line for higher-grade disease, where somatostatin analogues alone are weak.
Patients newly diagnosed with an advanced grade 2 or 3 neuroendocrine tumour of the gut or pancreas that shows somatostatin receptors on imaging can now receive lutetium dotatate as their first treatment, gaining more than a year of additional disease control and a much higher chance of tumour shrinkage. It does not settle whether radioligand therapy is better than other first-line options such as capecitabine-temozolomide or everolimus, and long-term marrow safety with earlier use needs surveillance.
Shares Dosimetry, Grade 3 well-differentiated neuroendocrine tumour, Theranostics, Somatostatin receptor 2.
Shares Grade 3 well-differentiated neuroendocrine tumour, Lutetium-177 dotatate, Small intestinal neuroendocrine tumours, Pancreatic neuroendocrine tumours.
Shares Jonathan R. Strosberg, Grade 3 well-differentiated neuroendocrine tumour, Somatostatin receptor 2, Small intestinal neuroendocrine tumours.
Shares Somatostatin receptor 2, Lutetium-177 dotatate, Small intestinal neuroendocrine tumours, Pancreatic neuroendocrine tumours.
Shares Theranostics, Somatostatin receptor 2, Small intestinal neuroendocrine tumours, Pancreatic neuroendocrine tumours.
Shares Grade 3 well-differentiated neuroendocrine tumour, Theranostics, Somatostatin receptor 2, Lutetium-177 dotatate.
Shares Grade 3 well-differentiated neuroendocrine tumour, Somatostatin receptor 2, Small intestinal neuroendocrine tumours, Pancreatic neuroendocrine tumours.
Shares Dosimetry, Grade 3 well-differentiated neuroendocrine tumour, Lutetium-177 dotatate, Small intestinal neuroendocrine tumours.