177Lu-Dotatate plus ocreotide as a first line therapy in neuroendocrine tumors

The NETTER-2 trial, recently published on The Lancet, showed that first line ¹⁷⁷Lu-Dotatate plus octreotide significantly extended median progression-free survival in patients with advanced gastroenteropancreatic neuroendocrine tumors.

NETTER-2 was an open-label, randomised, parallel-group, superiority, phase 3 multicenter trial which enrolled 226 patients with newly diagnosed higher grade 2 and grade 3 somatostatin receptor-positive advanced gastroenteropancreatic neuroendocrine tumors. Participants were randomized to receive a radioligand therapy with ¹⁷⁷Lu-Dotatate plus intramuscular octreotide or high-dose ocreotide, with tumor assessments done at baseline, week 16, week 24 and then every 12 weeks until disease progression or death. Results showed a median progression-free survival of 8,5 months in the control group and 22,8 months in the ¹⁷⁷Lu-Dotatate group; moreover, there was an impressive improvement in the percentage of participants whose tumors responded to the treatment (43% in those who received both drugs versus 9% in those who only received octreotide, with a 5% of participants with a pathological complete response). The radiopharmaceutical ¹⁷⁷Lu-Dotatate is already approved for the treatment of advanced gastrointestinal and pancreatic neuroendocrine tumors; these new data suggests that «¹⁷⁷Lu-Dotatate should be considered a new standard of care in first-line therapy in this population», as authors conclude.