Resolution of Malignant Ascites and Stabilization of Metastases in a Patient With Small Bowel Neuroendocrine Tumor With 177Lu-DOTATATE Following Progression After 17 131I-MIBG Treatments and Chemotherapy.

A 39-year-old man diagnosed with a small bowel neuroendocrine tumor metastatic to the liver, lymph nodes, and bones achieved stable disease with ¹³¹I-MIBG therapy totalling 17 treatments over 9 years (cumulative dose of 1.9 Ci). His disease progressed after the 17th ¹³¹I-MIBG treatment, and he went on to fail chemotherapy, developing severe ascites requiring up to 8 L of weekly paracentesis. He was referred for ¹⁷⁷Lu-[DOTA⁰,Tyr³]octreotate (DOTATATE) therapy, and after 4 induction cycles, his ascites resolved completely, and his metastatic disease stabilized. ¹⁷⁷Lu-DOTATATE may be useful in patients with an extensive history of radioisotope therapy with ¹³¹I-MIBG.