SSTR positive

P1, N=18, Completed, Vastra Gotaland Region | Active, not recruiting --> Completed

P1/2, N=25, Recruiting, Fundación de investigación HM | Phase classification: P2 --> P1/2

P1, N=104, Recruiting, RayzeBio, Inc. | Not yet recruiting --> Recruiting | Trial completion date: Oct 2032 --> Apr 2033

Trial registration: EudraCT, 2019-004073-76. Registered 20/08/2020.

Most patients who experienced progression after PRRT continued to express SSTR, with a decrease in SUVmax SSTR-negative disease was rare, indicating that the majority remained eligible for retreatment with SSTR-targeted radioligands. SSTR PET identified disease progression in 46.7% of patients, emphasizing its essential role in detecting disease progression, particularly in nonmeasurable disease, such as that in bone.

P2/3, N=400, Recruiting, Cancer Institute and Hospital, Chinese Academy of Medical Sciences | Trial completion date: Dec 2025 --> Dec 2029 | Trial primary completion date: Dec 2024 --> Dec 2028

This case highlights the limited therapeutic efficacy of PRRT in RAIR-DTC, despite favorable imaging characteristics. It underscores the need for better patient selection and further research to clarify the role of PRRT in this population.

Age and weight did not show a clinically significant impact on 177Lu-DOTATATE exposure or kidney and bone marrow dosimetry values, confirming that flat dosing at adult dosage is appropriate for adolescents. 177Lu-DOTATATE with 7.4 GBq of activity, administered over 4 cycles 8 wk apart, is a well-tolerated therapeutic dosing regimen for adolescent patients with gastroenteropancreatic neuroendocrine tumors or pheochromocytomas and paragangliomas.

P1, N=10, Recruiting, University of Wisconsin, Madison | Trial completion date: Mar 2026 --> Jun 2026 | Trial primary completion date: Mar 2026 --> Jun 2026

In patients with radiologic progression requiring systemic disease control, targeted agents such as everolimus and sunitinib represent established subsequent options, particularly when disease stabilization is the primary therapeutic goal. Peptide receptor radionuclide therapy with 177Lu-DOTATATE has demonstrated meaningful antitumor activity and is generally considered in patients with SSTR-positive tumors with progressive disease (Ki-67 ≥ 10%) or increasing tumor burdens, especially when tumor reduction is desirable. Combination cytotoxic chemotherapy, most notably the capecitabine-temozolomide (CAPTEM) regimen, remains an important consideration for patients with higher tumor burdens or more aggressive tumor biology. This review summarizes current evidence and provides a practical overview of treatment selection and sequencing for the systemic management of Grade 1-2 pancreatic neuroendocrine tumors, while also highlighting emerging therapeutic strategies, including targeted alpha therapy and SSTR2 antagonist-based approaches.

This Delphi consensus provides pragmatic, multidisciplinary, and evidence-informed guidance to harmonize routine clinical practice in the use of PRRT for well-differentiated, SSTR-positive NETs. The proposed statements and the algorithm aim to harmonize practice across centers, reduce variability in care, enhance safety, and ultimately improve patient outcomes.