In 104 neuroendocrine tumor patients treated with 177Lu-DOTATATE PRRT, 74% completed all four cycles with an 18% response rate, but small bowel NETs had significantly longer time-to-failure than pancreatic NETs (37.3 vs 13.2 months), and serious adverse events occurred in ~40% of patients.
37.3 vs 13.2 monthsSmall bowel NETs had nearly 3x longer time-to-treatment failure than pancreatic NETs after PRRT, highlighting dramatic differences in response by tumor type
What the researchers found
74% completed all 4 PRRT cycles; 18% objective response rate. Small bowel NETs: median TTF 37.3 months vs pancreatic NETs 13.2 months (p=0.001). Independent predictors of TTF: Ki-67, primary site, liver tumor burden ≥50%. ~40% had grade ≥3 AEs. 10% discontinued for treatment-related AEs. 2 delayed nephrotic syndrome cases. 6 patients had rapid liver failure progression.
Why it matters
PRRT is increasingly used for advanced NETs, but clinical trial data (NETTER-1) included mostly small bowel NETs. This real-world study provides critical safety and efficacy data across NET subtypes, identifies patients at highest risk for serious complications, and reports previously unrecognized toxicities like delayed nephrotic syndrome.
The numbers in context
104 patients. 177Lu-DOTATATE 200 mCi administered every 8 weeks for 4 doses. December 2017 to October 2020.
How the study worked
Retrospective single-center analysis of 104 NET patients treated with 177Lu-DOTATATE (200 mCi every 8 weeks for 4 doses) at a US academic center from December 2017 to October 2020. Outcomes: objective response rate, time-to-treatment failure/death, adverse events. Multivariate analysis for predictive factors.
Who was studied
Neuroendocrine tumor patients receiving 177Lu-DOTATATE at a US academic center
What this study cannot tell us
Retrospective single-center study with inherent selection bias. No control group. Heterogeneous NET types and prior treatments. Small numbers for subgroup analyses of rare toxicities (2 nephrotic syndrome, 6 liver failure). Median follow-up not clearly stated.
How to read the evidence
Rated moderate: reasonably sized cohort (104 patients) with real-world data, but limited by retrospective single-center design without a control group.
When this study was published
Published in 2024. Covers patients treated from December 2017 to October 2020, providing mature follow-up data.
The bigger picture
As PRRT becomes more widely used for NETs, understanding real-world outcomes and toxicities is essential. This study reveals that not all NETs respond equally — pancreatic NETs fare significantly worse — and identifies serious adverse events (liver failure, delayed kidney damage) not well-characterized in pivotal trials.
Questions still open
- Should PRRT treatment protocols be modified for pancreatic NETs given their significantly worse outcomes?
- What risk factors predict the rare but devastating rapid liver failure progression after PRRT?
- Should routine kidney monitoring be extended to 2+ years post-PRRT given the delayed nephrotic syndrome cases?
Common questions
What is PRRT and how well does it work for neuroendocrine tumors?
Is PRRT safe? What are the side effects?
Read the original research
Safety and efficacy of peptide receptor radionuclide therapy in neuroendocrine tumors: A single center experience.
PloS one, 19(5), e0298824
Citation
Sukrithan, Vineeth; Armbruster, Heather; Rogers, Sherise; Vogt, Sherry Mori; Grenade, Cassandra; Verschraegen, Claire; Zhou, Ye; Goyal, Ashima; Natwa, Mona; Hussein, Akram; Barr, Hallie; Konate, Dramane; Batdorf, Rochelle; Brown, Andrew; Williams, Bonnie; Zhao, Songzhu; Wei, Lai; Xu, Menglin; Shah, Manisha H; Konda, Bhavana. (2024). Safety and efficacy of peptide receptor radionuclide therapy in neuroendocrine tumors: A single center experience.. PloS one, 19(5), e0298824. https://doi.org/10.1371/journal.pone.0298824