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AJR Am J Roentgenol. 2018 Aug;211(2):278-285. doi: 10.2214/AJR.18.19953. Epub 2018 Jun 27.

Neuroendocrine Tumor Therapy: 177Lu-DOTATATE.

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1
1 Department of Diagnostic Radiology, Division of Nuclear Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code L340, Portland, OR 97239.

Abstract

OBJECTIVE:

The purposes of this article are to increase understanding of the concepts of theranostics and peptide receptor radionuclide therapy (PRRT) as they apply to neuroendocrine tumors (NETs); review the key 1, 2, and 3 clinical trial data leading to the approval of 177Lu-tetraazacyclododecanetetraacetic acid-octreotide (177Lu-DOTATATE); and foster understanding of the practical aspects and future directions of PRRT for NETs.

CONCLUSION:

In January 2018, 177Lu-DOTATATE therapy was approved in the United States (previously approved in Europe in September 2017) for adult patients with somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors, including those of the foregut, midgut, and hindgut. The results of the phase 3 Neuroendocrine Tumors Therapy (NETTER-1) trial show favorable outcomes with respect to the primary endpoint of progression-free survival and a host of secondary objectives, including overall survival, objective response rate, and quality of life measures. Patient selection is based on a number of specific factors and should be sequenced carefully with respect to other available therapies, ideally in multidisciplinary cancer conferences. Establishing the therapy at a new institution can be somewhat involved, but once it is established, the therapy is fairly straightforward to administer and is well tolerated with limited side-effects and toxicity. A number of approaches and issues are still to be worked out, and this therapy will continue to be studied and optimized.

KEYWORDS:

177Lu; DOTATATE; NETTER-1 trial; neuroendocrine tumors; peptide receptor radionuclide therapy

PMID:
29949416
DOI:
10.2214/AJR.18.19953

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