Monitoring and Surveillance of Patients with Gastroenteropancreatic Neuroendocrine Tumors Undergoing Radioligand Therapy

SIMPLE SUMMARY: Radioligand therapy with [(177)Lu]Lu-DOTA-TATE is a therapeutic option for adult patients with somatostatin-receptor–positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Patients undergoing radioligand therapy require diligent monitoring and surveillance. While published guidelines can provide guidance on general approaches to care, GEP-NETs are heterogeneous and the guidelines can be difficult to apply in individual and complex cases. In this article, we discuss emerging evidence on imaging, clinical biochemistry, and tumor assessment criteria in the management of patients receiving radioligand therapy for GEP-NETs as well as our own best practices. We offer practical guidance on how to effectively implement monitoring and surveillance measures to aid patient-tailored clinical decision-making. ABSTRACT: Radioligand therapy (RLT) with [(177)Lu]Lu-DOTA-TATE is a standard of care for adult patients with somatostatin-receptor (SSTR)-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Taking advantage of this precision nuclear medicine approach requires diligent monitoring and surveillance, from the use of diagnostic SSTR-targeted radioligand imaging for the selection of patients through treatment and assessments of response. Published evidence-based guidelines assist the multidisciplinary healthcare team by providing acceptable approaches to care; however, the sheer heterogeneity of GEP-NETs can make these frameworks difficult to apply in individual clinical circumstances. There are also contradictions in the literature regarding the utility of novel approaches in monitoring and surveilling patients with GEP-NETs receiving RLT. This article discusses the emerging evidence on imaging, clinical biochemistry, and tumor assessment criteria in the management of patients receiving RLT for GEP-NETs; additionally, it documents our own best practices. This allows us to offer practical guidance on how to effectively implement monitoring and surveillance measures to aid patient-tailored clinical decision-making.