The role of peptide receptor radionuclide therapy with Lu-177 Dotatate in metastatic gastroenteropancreaticneuroendocrine tumors.

Peptide Receptor Radionuclide Therapy (PRRT) has emerged as an established treatment modality for patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs), particularly in the second-line setting following progression on somatostatin analogs. Evidence from trials such as NETTER-1 and NETTER-2 has demonstrated significant improvements in progression-free survival and objective response rates, with expanding indications into first-line treatment and higher-grade disease. Emerging data from comparative and combination studies highlight the potential role of PRRT alongside targeted therapies and chemotherapy, although uncertainties remain regarding optimal sequencing and overall survival benefit. Retreatment strategies, special population considerations, and novel approaches including alpha-emitting radionuclides and somatostatin receptor antagonists further broaden the therapeutic landscape. Ongoing prospective trials are expected to refine patient selection and define the future role of PRRT across different tumor grades and clinical scenarios.