A Clinical Guide to Peptide Receptor Radionuclide Therapy with (177)Lu-DOTATATE in Neuroendocrine Tumor Patients

SIMPLE SUMMARY: Peptide receptor radionuclide therapy (PRRT) is one of the treatment options for locally advanced or metastatic gastroenteropancreatic (GEP) neuroendocrine tumors (NETs). This treatment makes use of radioactive labeled somatostatin analogues, with (177)Lu-DOTATATE as its established standard. PRRT has positive effects in tumor control and it lowers the risk of disease progression or death. It also improves the quality of life of the patient. Unfortunately, important risk factors for a minority of patients include renal and hematological toxicities. NET is a rare disease and treating patients with PRRT requires clinical expertise. This guide gives an overview of the background of PRRT and the current results in NET patient care. ABSTRACT: Peptide receptor radionuclide therapy (PRRT) with [(177)Lu]Lu-[DOTA(0),Tyr(3)]-octreotate ((177)Lu-DOTATATE) has become an established second- or third-line treatment option for patients with somatostatin receptor (SSTR)-positive advanced well-differentiated gastroenteropancreatic (GEP) neuroendocrine tumors (NETs). Clinical evidence of the efficacy of PRRT in tumor control has been proven and lower risks of disease progression or death are seen combined with an improved quality of life. When appropriate patient selection is performed, PRRT is accompanied by limited risks for renal and hematological toxicities. Treatment of NET patients with PRRT requires dedicated clinical expertise due to the biological characteristics of PRRT and specific characteristics of NET patients. This review provides an overview for clinicians dealing with NET on the history, molecular characteristics, efficacy, toxicity and relevant clinical specifics of PRRT.