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

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 the context of a clinical trial. This all assumes the tumors express somatostatin receptors as manifested by PET receptor imaging such as Ga68 or Cu64 DOTA PET.

It is reasonable to start patients on soma...

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 either not express SS or have heterogenous weak SS expression which is highly predictive for response to PRRT. In addition, there are some small retrospective data showing that if these patients have posi...