Neuroendocrine
tumor (NET)
treatment guidelines
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Treatment guidelines
International guidelines recommend peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE* after progression on first-line somatostatin analogs (SSAs)1-5
The table below summarizes recommendations from medical societies on the sequencing of 177Lu-DOTATATE* for the treatment of GEP-NETs. Click on the guidelines to read the recommendations.
Consensus on molecular imaging and theranostics in neuroendocrine neoplasms1
- PRRT is recommended as second-line treatment after progression or lack of symptomatic control on SSAs, for patients with nonresectable or disseminated somatostatin receptor (SSTR)-positive gastrointestinal NETs
- Most panellists (71.4%) chose 177Lu-DOTATATE as their preferred radiopharmaceutical for treating NET patients
NET, neuroendocrine tumor; PRRT, peptide receptor radionuclide therapy; SSA, somatostatin analog; SSTR, somatostatin receptor.
European Neuroendocrine Tumor Society (ENETS), 20162
- For midgut NET patients, PRRT with 177Lu-DOTATATE is recommended as a second-line therapy after progression on SSAs
- For patients with functional, SSTR-positive pancreatic NET (pNET), PRRT with 177Lu-DOTATATE is recommended as a second-line therapy. In low grade, non-functional pNETs, PRRT with 177Lu-DOTATATE is recommended as a third-line therapy
ENETS, European Neuroendocrine Tumor Society; NET, neuroendocrine tumor; pNET, pancreatic neuroendocrine tumor; SSA, somatostatin analog.
European Society for Medical Oncology (ESMO) – 2020 update3
- PRRT with 177Lu-DOTATATE is recommended as a second-line therapy in patients with midguts NETs after progression on SSA
- PRRT with 177Lu-DOTATATE can be considered in both functioning and non-functioning NETs with positive SSTR scintigraphy irrespective of the primary tumor site
ESMO, European Society for Medical Oncology; NET, neuroendocrine tumor; PRRT, peptide receptor radionuclide therapy; SSA, somatostatin analog; SSTR, somatostatin receptor.
NANETS/SNMMI Consensus Statement on Patient Selection and Appropriate Use of 177Lu-DOTATATE Peptide Receptor Radionuclide Therapy, 20204
- PRRT with 177Lu-DOTATATE should be considered in patients with SSTR-positive midgut NET at time of progression after treatment with first-line SSA therapy (appropriateness score 9/9*)
- PRRT with 177Lu-DOTATATE should be considered for treatment of patients with progressive pNET (appropriateness score 8/9*)
*Scores 7 to 9 indicate that the use of the procedure is appropriate for the specific scenario and is generally considered acceptable.
NANETS, North American Neuroendocrine Tumor Society;
NET, neuroendocrine tumor;
pNET, pancreatic neuroendocrine tumor;
PRRT, peptide receptor radionuclide therapy;
SNMMI, Society of Nuclear Medicine and Molecular Imaging;
SSA, somatostatin analog;
SSTR, somatostatin receptor.
US National Comprehensive Cancer Network (NCCN), 20215
- PRRT with 177Lu-DOTATATE is a category 1* recommended option for use after progression on a SSA in SSTR-positive, progressive midgut NETs
- PRRT with 177Lu-DOTATATE is a category 2A** recommended option for use after progression on a SSA in SSTR-positive, progressive GEP-NETs other than midgut NETs, including pNETs
*Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. **Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. GEP-NET, gastroenteropancreatic neuroendocrine tumor; NCCN, National Comprehensive Cancer Network; NET, neuroendocrine tumor; pNET, pancreatic neuroendocrine tumor; SSA, somatostatin analog; SSTR, somatostatin receptor.
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