The case for combined chemotherapy-peptide receptor radionuclide therapy (chemo-PRRT) strategy in metastatic neuroendocrine tumor: predicting and looking at the possible case scenarios

Excerpt

Peptide receptor radionuclide therapy (PRRT) with ¹⁷⁷Lu-DOTATATE has gained substantial popularity and is typically employed in the management of grade I and Grade II metastatic neuroedocrine tumors (NETs). In routine clinics, however, the application of PRRT is frequently considered and has been extended up to a Mib1 labeling index (LI) of up to 30 %, when adequate tracer uptake is noted in the ⁶⁸Ga-DOTATATE positron emission tomography–computed tomography (PET-CT) [1‐3]. Combining chemotherapy with PRRT is an attractive therapeutic option for patients with relatively aggressively behaving metastatic neuroedocrine tumors (NETs) where it is unlikely to achieve favourable response to a single treatment strategy. It is thus quite important to predict and identify a priori the patients who would need this approach rather than having them follow what will be considered as a failed regimen. …