DOTATOC PET showed no uptake in the pancreatic lesion but revealed high uptake in the primary ASPS in scapula and previously unrecognized metastases in the breast and skull, indicating high somatostatin receptor (SSTR) expression. To our knowledge, this is the first report of DOTATOC uptake in ASPS, which raises the prospect of SSTR-targeted treatment with 177Lu-DOTATATE.

Hybrid PET/MRI improves hepatic lesion characterization and reduces radiation in appropriate patients, while CT/MRI remains indispensable for morphology and complications. Integrating multi-tracer PET with anatomic imaging refines risk stratification, PRRT selection, and longitudinal response assessment.

P2, N=10, Recruiting, OHSU Knight Cancer Institute | Not yet recruiting --> Recruiting | Trial completion date: Dec 2026 --> Dec 2027 | Trial primary completion date: Dec 2026 --> Dec 2027

The 213Bi daughter mostly remained with DOTATATE in tumors, decaying at the same location as 221Fr. The favorable tumor-to-normal tissue absorbed dose ratio of [225Ac]Ac-DOTATATE supports its use in patients with SSTR-expressing GEP-NETs.

P2, N=146, Recruiting, Institut du Cancer de Montpellier - Val d'Aurelle | Trial completion date: Oct 2031 --> Oct 2033 | Trial primary completion date: Oct 2031 --> Oct 2033

Tandem RLT was associated with low rates of severe late toxicity, even after very prolonged follow-up and repeated treatment courses, although gradual long-term decline in renal function was common. These data provide a rare long-term real-world benchmark for late toxicity of high-energy β-emitter-based RLT and support the long-term feasibility of tandem RLT in selected patients with NETs.

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.

Our study provides systematic preclinical evidence of sex-dependent pharmacokinetic differences in 177Lu-DOTATATE, with females demonstrating significantly higher systemic exposure than males at specific dose levels. These findings establish the systematic preclinical evidence base for sex-dependent pharmacokinetic differences in 177Lu-DOTATATE, providing a scientific rationale for incorporating sex as a stratification variable in future dosimetry-guided clinical studies.

Respiratory motion is an important factor for modelling realistic patient images, in the context of quantitative SPECT and PET. Non-spherical tumours and background variability has a minor, but measurable impact.

P2, N=25, Suspended, National Cancer Centre, Singapore | Trial completion date: Sep 2025 --> Sep 2027 | Recruiting --> Suspended | Trial primary completion date: Dec 2024 --> Dec 2026

P2, N=153, Suspended, RTOG Foundation, Inc. | Recruiting --> Suspended

In this exploratory paired target-lesion analysis, semiquantitative SSTR PET metrics showed significant treatment-related changes after 177Lu-DOTATATE, whereas paired single-lesion size changes on contrast-enhanced CT were modest. These findings support the presence of molecular-morphologic discordance after PRRT and suggest that normalized PET-derived metrics deserve further investigation as practical tools for post-treatment assessment in GEP-NENs.