SSTR positive

Radionuclide therapy in GEP-NETs is transitioning from a late-line option toward a flexible, biology-driven treatment strategy with important implications for clinical practice.

Current data suggest that PRRT, traditionally approved as a later-line therapy, may play a promising role in neoadjuvant and first-line settings for selected GEP-NET patients, enhancing resectability, improving surgical outcomes, and potentially prolonging survival. Further prospective, randomized studies are needed to define selection criteria, determine optimal timing, and assess the long-term impact on disease trajectory.

Using sunitinib as an internal control, our results show clinically significant antitumour efficacy of [177Lu]Lu-dota-tate in pretreated, progressive, somatostatin receptor-positive, metastatic pancreatic neuroendocrine tumours, and a better quality of life during the treatment phase. Late adverse events were reported in the [177Lu]Lu-dota-tate group that might affect the tolerance of subsequent lines of treatment.

Theranostic radiopharmaceutical therapy has moved from niche practice to mainstream oncology, anchored by approvals of lutetium Lu 177 dotatate for somatostatin receptor-positive neuroendocrine tumors and lutetium Lu 177 vipivotide tetraxetan for PSMA-positive prostate cancer. Yet the field's future depends on rigorous clinical trial design, realistic operational planning, and workforce readiness. This review summarizes how theranostics evolved, outlines current regulatory and trial-design yardsticks (including dose optimization and expectations for assessment of late-toxicity), and provides a practical framework for nuclear medicine physicians to assess protocols and prepare their practices for expanding indications and combinations.

P1, N=10, Active, not recruiting, Memorial Sloan Kettering Cancer Center | Trial completion date: Sep 2026 --> Sep 2027 | Trial primary completion date: Sep 2026 --> Sep 2027

P=N/A, N=164, Completed, Novartis Pharmaceuticals | Active, not recruiting --> Completed

In SSTR-directed PET/CT, a distinction between PMT and bone fracture may be possible with a SUVmax threshold of 7.6. The integration of PET derived TLU, along with TmP/GFR may improve diagnosis and treatment planning for TIO.

Baseline NSE elevation and early post-treatment declines may serve as potential prognostic indicators. These results are hypothesis-generating and warrant validation in larger, multicenter studies.

NF-pNET-mimicking SCA is an uncommon but clinically consequential benign mimic. In the available retrospective comparative cohorts of resected, pathology-proven lesions, lower unenhanced CT attenuation (and attenuation ratios) and higher DWI-ADC values consistently favored SCA over NF-pNET, whereas arterial hyperenhancement and positive somatostatin receptor imaging uptake were not specific. These findings may support cautious multiparametric assessment in selected hypervascular solid-appearing pancreatic lesions, but should not be applied as definitive diagnostic thresholds without external validation.

After everolimus failure, he received 177Lu-DOTATATE (Lutathera®). Stable disease was maintained for 12 months without severe adverse events, preserving quality of life. 177Lu-PRRT is a promising therapeutic option for high-grade, somatostatin receptor-positive renal NET when other treatments fail.

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