Considering Frontline PRRT in NETs
Key Points
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Use of peptide receptor radionuclide therapy (PRRT) in the frontline treatment of neuroendocrine tumors (NETs) was among the topics covered at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting.
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Certain data indicate that PRRT is more effective than a somatostatin analogue (SSA) in the first-line setting for gastroenteropancreatic NETs.
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Despite these findings, clinicians may still select upfront chemotherapy for this patient population.
At the 2025 ASCO Annual Meeting, Shruti Patel, MD, of Stanford Medicine, shared insight about the use of first-line PRRT in patients with NETs. In a discussion with Neena Vijayvergia, MD, of Fox Chase Cancer Center, Dr. Patel explained when and why she would consider upfront PRRT, citing the NETTER-2 trial.
In the study, investigators compared 177Lu-Dotatate, a type of PRRT, plus octreotide with octreotide alone in the frontline treatment of patients with gastroenteropancreatic NETs who had Ki-67 scores of 10% to 55%. Compared with the monotherapy arm, the combination arm showed significantly improved median progression-free survival (8.5 months vs 22.8 months, respectively).
“I’m not surprised by that result. It’s an effective therapy, but the problem with neuroendocrine tumors is they are very heterogeneous,” Dr. Vijayvergia said. A Ki-67 score of 10% in a biopsy sample may not be representative of the entire NET, she said.
Dr. Vijayvergia went on to explain that she rarely chooses PRRT as the frontline treatment for pancreatic NETs. Typically, she starts patients who are very symptomatic with chemotherapy. Conversely, for asymptomatic patients, she will begin with a SSA and perform regular scans. PRRT will begin if a patient’s disease is worsening with a SSA.