Would you consider 177Lu-Dotatate (Lutathera) in patients with midgut neuroendocrine carcinoma after treatment with a somatostatin analog but with Ki67 >20%?

Topics: Radiation Oncology • Gastrointestinal Cancers • Medical Oncology • Nuclear Medicine

This patient had a Ki67 of 27%. However, the inclusion criteria for the NETTER-1 Trial was Ki67<20%. Would Lutathera be an option if labs are within normal limits?

Answer from: Medical Oncologist at Academic Institution

PRRT with Lu-177 DOTATATE can certainly be considered in patients with well-differentiated G3 NETs. The expected outcomes are not as favorable as with G1/G2 NETs but better than with poorly differentiated G3 neuroendocrine carcinoma (G3 NEC) where PRRT should probably not be used at all unless in th...

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Radiation Oncologist at East Alabama Medical Center
Thank you very much!

Answer from: Medical Oncologist at Community Practice

Management of G3 GEP-NET can be challenging. We usually discuss these cases carefully at the NET TB to ensure that this is GE NET (well diff) vs G3 NEC (poorly diff). The second step is to make sure that all these lesions have homogenous strong intense SS expression given that higher grades can eith...

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