SSTR positive

Age and weight did not show a clinically significant impact on 177Lu-DOTATATE exposure or kidney and bone marrow dosimetry values, confirming that flat dosing at adult dosage is appropriate for adolescents. 177Lu-DOTATATE with 7.4 GBq of activity, administered over 4 cycles 8 wk apart, is a well-tolerated therapeutic dosing regimen for adolescent patients with gastroenteropancreatic neuroendocrine tumors or pheochromocytomas and paragangliomas.

P1, N=10, Recruiting, University of Wisconsin, Madison | Trial completion date: Mar 2026 --> Jun 2026 | Trial primary completion date: Mar 2026 --> Jun 2026

In patients with radiologic progression requiring systemic disease control, targeted agents such as everolimus and sunitinib represent established subsequent options, particularly when disease stabilization is the primary therapeutic goal. Peptide receptor radionuclide therapy with 177Lu-DOTATATE has demonstrated meaningful antitumor activity and is generally considered in patients with SSTR-positive tumors with progressive disease (Ki-67 ≥ 10%) or increasing tumor burdens, especially when tumor reduction is desirable. Combination cytotoxic chemotherapy, most notably the capecitabine-temozolomide (CAPTEM) regimen, remains an important consideration for patients with higher tumor burdens or more aggressive tumor biology. This review summarizes current evidence and provides a practical overview of treatment selection and sequencing for the systemic management of Grade 1-2 pancreatic neuroendocrine tumors, while also highlighting emerging therapeutic strategies, including targeted alpha therapy and SSTR2 antagonist-based approaches.

This Delphi consensus provides pragmatic, multidisciplinary, and evidence-informed guidance to harmonize routine clinical practice in the use of PRRT for well-differentiated, SSTR-positive NETs. The proposed statements and the algorithm aim to harmonize practice across centers, reduce variability in care, enhance safety, and ultimately improve patient outcomes.

P=N/A, N=11, Active, not recruiting, Memorial Sloan Kettering Cancer Center | Recruiting --> Active, not recruiting | N=50 --> 11

P1/2, N=2, Completed, Crinetics Pharmaceuticals Inc. | Active, not recruiting --> Completed

P2, N=10, Active, not recruiting, Antonio Fojo | Trial completion date: Mar 2026 --> Mar 2027 | Trial primary completion date: Mar 2026 --> Mar 2027

P1, N=15, Recruiting, Emory University | Not yet recruiting --> Recruiting | Trial completion date: Sep 2026 --> Sep 2027 | Trial primary completion date: Sep 2025 --> Sep 2026

A personalized, multidisciplinary approach is essential for maximizing PRRT's benefits in NET management. This review article summarizes current evidence and describes patient specific circumstances, enabling treating provider to make informed PRRT sequencing decisions.

PRRT combined with everolimus-based immunosuppression has demonstrated controllable safety and preliminary antitumor activity in patients with relapsed NETLM after LT who have been strictly screened, but myelosuppression requires close monitoring and timely symptomatic treatment.

We hypothesize the amino-acid infusion, which is supportive therapy given prior to PRRT, caused vasodilatation in the pre-existing angiodysplastic lesion. The vasodilatation together with the high venous pressure due to tumoral invasion of the mesenteric vein may have aggravated bleeding symptoms.