Neuroendocrine tumours (NETs) of the midgut are rare, often indolent tumours. However, many patients are diagnosed with metastatic incurable disease at initial presentation. Due to their anti-secretory and anti-proliferative actions, somatostatin analogues are used as first-line systemic therapy. To date, cytotix chemotherapy, radiotherapy and newer biological agents have not been found to be effective in managing metastatic disease.

Recently, Strosberg and colleagues reported results from the Neuroendocrine Tumours Therapy (NETTER-1) Study, a phase 3 randomised controlled trial (RCT) evaluating the efficacy and safety of ¹⁷⁷Lu-Dotatate compared with high dose octreotide LAR in advanced progressive somatostatin receptor-positive midgut NETs.

¹⁷⁷Lu-Dotatate treatment resulted in a significantly longer progression-free survival rate and higher response rate. In a planned interim analysis, overall survival also increased following ¹⁷⁷Lu-Dotatate therapy. However, clinically significant haematological toxicity occurred in 10% of those treated.

This is the first RCT to demonstrate ¹⁷⁷Lu-Dotatate as an efficacious second-line treatment in advanced and progressive midgut NETs. This further supports provision of ¹⁷⁷Lu-Dotatate to such patients in England, in line with other countries, and guidance such as that from the European Neuroendocrine Tumour Society.

Read the full article in New England Journal of Medicine 376 125–135