Lutetium-177 Dotatate: Radioligand Therapy for Neuroendocrine Tumours

Table of Contents

1. Lutetium-177 Dotatate at a Glance
2. How the Radiation Reaches the Tumour
3. Finding the Receptor With a Dotatate Scan
4. How the Label Says It Is Given
5. NETTER-1: Tumours That Grew on Octreotide
6. NETTER-2: The First Treatment for Grade 2 and 3 Tumours
7. Quality of Life and Daily Symptoms
8. The Label Warnings
9. Long-Term Blood-Cancer and Kidney Risk in Cohort Studies
10. Radiation Safety in the Label's Words
11. Adolescents Aged 12 to 17
12. What Is Not Known
13. Regulatory Documents
14. Key Research Papers
15. Connections
16. Featured Videos

Lutetium-177 Dotatate at a Glance

• What it is: a radiolabelled somatostatin analog. A ring-shaped peptide (dotatate) is held to the radioactive metal lutetium-177 by a chemical cage called a chelator, as the label describes it.
• Approved for: adults and children aged 12 years and older with somatostatin-receptor-positive gastroenteropancreatic neuroendocrine tumours, including foregut, midgut and hindgut tumours (FDA label).
• U.S. approvals: January 26, 2018, a new molecular entity under priority review (New Drug Application 208700); April 23, 2024, an efficacy supplement under priority review that added patients aged 12 and older (Drugs@FDA).
• Label schedule: 7.4 gigabecquerels (GBq), which is 200 millicuries (mCi), every 8 weeks (plus or minus 1 week) for a total of 4 doses.
• Label warnings: radiation exposure, myelosuppression (low blood counts), secondary myelodysplastic syndrome and leukaemia, kidney toxicity, liver toxicity, hypersensitivity reactions, neuroendocrine hormonal crisis, harm to an unborn baby, and infertility. The label lists no contraindications.
• Main evidence: NETTER-1 (231 people, tumours of the small intestine that grew on octreotide) and NETTER-2 (226 people, newly diagnosed grade 2 and 3 tumours). The manufacturer funded both trials.

How the Radiation Reaches the Tumour

Somatostatin is a natural hormone that switches off the release of other hormones. Its receptors come in five subtypes. The label states that lutetium-177 dotatate binds somatostatin receptors with the highest affinity for subtype 2, and that once it binds to a receptor-bearing cell the compound is taken inside the cell. The lutetium-177 then gives off beta-minus particles (fast electrons). The label says this radiation causes cell damage by forming free radicals, in the receptor-positive cells and in neighbouring cells.

The particles travel only a short way. The label gives a maximum reach in tissue of 2.2 mm and an average of 0.67 mm, so most of the dose stays near the cells that took up the drug. Lutetium-177 decays to stable hafnium-177 with a half-life of 6.647 days. The label states that it also gives off some gamma rays (photons).

Most of the drug that does not stick to tumour cells leaves through the kidneys. The label reports that 44% of the radioactivity is passed in the urine within 5 hours, 58% within 24 hours and 65% within 48 hours, and that more than 99% of the given radioactivity is gone within 14 days. Within 4 hours of the infusion the drug is found in the kidneys, the tumours, the liver and the spleen, and in some people in the pituitary and thyroid glands. In the NETTER-1 measurements, the average radiation dose over four treatments was 19.4 gray to the kidneys, 25.1 gray to the spleen and 1.0 gray to the red bone marrow.

Because ordinary somatostatin analogs such as octreotide occupy the same receptors, the label states that they may interfere with the treatment. Long-acting forms are stopped at least 4 weeks before each dose, and short-acting octreotide at least 24 hours before. The label also states that glucocorticoid (steroid) medicines can reduce the number of subtype 2 receptors on cells, and it warns against repeated high doses during treatment.

Finding the Receptor With a Dotatate Scan

The treatment only reaches tumours that carry somatostatin receptors, so the receptors are shown on a scan first. The same dotatate molecule can carry a different radioactive metal that is made for imaging rather than treatment. Paired with gallium-68 or copper-64, it lights up receptor-bearing tumours on a positron emission tomography (PET) scan. Using one molecule to find a target and a sister molecule to treat it is often called "theranostics".

• The older test in NETTER-1: the label states that NETTER-1 required somatostatin receptors on all lesions, shown by uptake on an indium-111 pentetreotide scan at least as strong as normal liver.
• Gallium-68 dotatate PET: in a study of 78 people, gallium-68 dotatate PET combined with computed tomography or liver magnetic resonance imaging changed care in 28 (36%). It was equivalent or superior to the indium-111 scan in all 78 and correctly identified 3 people as candidates for receptor-targeted radiation treatment whom the indium-111 scan had classified wrongly (Deppen 2016).
• Copper-64 dotatate PET: in a U.S. trial with 42 people with neuroendocrine tumours and 21 healthy volunteers, masked readers found 90.9% sensitivity and 96.6% specificity, which became 100.0% and 96.8% after an error in the reference diagnosis was corrected. No side effects were linked to the tracer (Delpassand 2020).
• NETTER-2: the trial required somatostatin receptors in all target lesions (Singh 2024).

The scan gives information about receptors, not a promise of response. Grade, tumour size, earlier treatments and blood counts also shape who receives the drug, as a 2022 clinical guide describes (Becx 2022).

How the Label Says It Is Given

The label sets 7.4 GBq every 8 weeks (plus or minus 1 week) for a total of 4 doses, for adults and for children aged 12 and older. Each dose drips into a vein over about 30 to 40 minutes; the label states it is not given as a fast push (bolus). The full course delivers 29.6 GBq.

• Amino acid kidney protection: an infusion of a sterile amino acid solution containing L-lysine and L-arginine starts 30 minutes before the dose and runs during it and for at least 3 hours after it. The label specifies 18 to 25 g of L-lysine hydrochloride and 18 to 25 g of L-arginine hydrochloride in 1 to 2 litres. The label states that these amino acids reduce reabsorption of the drug in the kidney tubules and lower the radiation dose to the kidneys; giving them reduced the median kidney dose by 47%. The amino acid dose is not lowered when a reduced dose of the radioactive drug is given.
• Anti-sickness medicine: the label lists anti-nausea medicine before the amino acid solution.
• Octreotide alongside: long-acting octreotide 30 mg is given into a muscle 4 to 24 hours after each dose, then every 4 weeks after the last dose until the disease progresses or for 18 months from the start, at the physician's discretion.
• Allergy watch: the label calls for close monitoring for at least 2 hours during and after the infusion in a setting with resuscitation equipment.
• Pregnancy check: the label calls for pregnancy status to be verified before the first dose.
• Lower doses: when blood counts fall, kidney or liver tests change, or other severe side effects occur, the label withholds the next dose, then resumes at half the dose (3.7 GBq). The treatment stops for good if a side effect pushes the gap between doses beyond 16 weeks or comes back.

The label states that the medicine is handled only by staff trained and licensed in radiopharmaceuticals, with waterproof gloves, radiation shielding and tongs for the vial.

NETTER-1: Tumours That Grew on Octreotide

NETTER-1 enrolled people with advanced, well-differentiated, somatostatin-receptor-positive neuroendocrine tumours of the midgut (mostly the small intestine) whose disease had grown while they were on a standard dose of long-acting octreotide. In the first report, 229 people were randomly assigned to four doses of 7.4 GBq every 8 weeks plus octreotide 30 mg (116 people) or to a doubled octreotide dose of 60 mg every 4 weeks (113 people). The trial was open-label: patients and doctors knew which treatment was given.

• Progression-free survival (time alive without the tumour growing): the estimated share without progression at 20 months was 65.2% with lutetium-177 dotatate and 10.8% with high-dose octreotide (Strosberg 2017). The label gives a hazard ratio of 0.21, meaning the risk of progression or death at any point was about one-fifth as high; the median was not reached in the lutetium group and was 8.5 months with high-dose octreotide.
• Tumour shrinkage: 18% versus 3% in the first report (Strosberg 2017).
• Early blood effects: severe (grade 3 or 4) neutropenia, thrombocytopenia and lymphopenia occurred in 1%, 2% and 9% of the lutetium group, and in none of the octreotide group. There was no sign of kidney damage during the time observed (Strosberg 2017).

Final overall survival

An early analysis had shown fewer deaths with lutetium-177 dotatate (14 versus 26), and the authors wrote that confirmation would need the final analysis. That final analysis came 5 years after the last person joined, when 142 of 231 people had died, with a median follow-up of about 76 months. Median overall survival was 48.0 months with lutetium-177 dotatate and 36.3 months with high-dose octreotide. The hazard ratio was 0.84 and the two-sided p value 0.30, so the difference was not statistically significant and the overall-survival goal was not met (Strosberg 2021). The authors wrote that the 11.7-month difference "might be considered clinically relevant". The label likewise states there was no statistically significant difference in overall survival.

One reason offered for the result is crossover. Reviews that read the full report state that 41 of the 114 people in the octreotide group (36%) later received radioligand treatment during follow-up, 26 of them within 24 months of joining (Chauhan 2022; Becx 2022). People who switch blur the comparison of survival between the two groups.

In long-term follow-up, 2 of 111 people (2%) given lutetium-177 dotatate developed myelodysplastic syndrome (MDS), a bone-marrow disorder that can turn into leukaemia. One of them died 33 months after joining; this was the only death reported as caused by the treatment. No new cases of myelodysplastic syndrome or acute myeloid leukaemia (AML) appeared during long-term follow-up (Strosberg 2021).

NETTER-2: The First Treatment for Grade 2 and 3 Tumours

NETTER-2 asked a different question: whether lutetium-177 dotatate helps as the first treatment, straight after diagnosis, in faster-growing tumours. It enrolled people aged 15 and older with newly diagnosed, advanced, well-differentiated gastroenteropancreatic neuroendocrine tumours of higher grade 2 (Ki-67 10% to 20%) or grade 3 (Ki-67 above 20% and up to 55%), with somatostatin receptors in all target lesions. Ki-67 is a stain that shows how many tumour cells are dividing.

Across 45 centres in nine countries, 226 people were randomly assigned in a 2-to-1 ratio to four cycles of lutetium-177 dotatate plus octreotide 30 mg (151 people) or to high-dose octreotide 60 mg every 4 weeks (75 people). The trial was open-label, but tumour growth was judged by blinded central radiologists.

• Progression-free survival: median 22.8 months with lutetium-177 dotatate versus 8.5 months with high-dose octreotide, a stratified hazard ratio of 0.276 (p < 0.0001) (Singh 2024).
• Side effects: during the treatment period, side effects of any grade occurred in 136 of 147 treated people (93%) in the lutetium group and 69 of 73 (95%) in the octreotide group. There were no study-drug-related deaths during the treatment period (Singh 2024).
• Overall survival: not reported in the primary paper.

The trial authors wrote that the combination should be considered a new standard first treatment for this group. A 2026 commentary on trial design took a more cautious view. Its authors pointed to higher toxicity, the absence of a demonstrated overall-survival or quality-of-life benefit, the open-label design and a possibly suboptimal comparison treatment, and wrote that these complicate the reading of the result (de Jong 2026). The FDA label's clinical-studies section, as read for this page, describes NETTER-1 and the Dutch ERASMUS cohort and does not describe NETTER-2.

Quality of Life and Daily Symptoms

NETTER-1 asked patients to fill in standard cancer questionnaires every 12 weeks until the tumour grew. The analysis measured the time until a score worsened by 10 points or more. This time was longer with lutetium-177 dotatate for global health status (hazard ratio 0.406), physical functioning (0.518), role functioning (0.580), fatigue (0.621), pain (0.566), diarrhoea (0.473), disease-related worries (0.572) and body image (0.425). The median time to a worsening of global health status was 28.8 months versus 6.1 months, and of physical functioning 25.2 versus 11.5 months (Strosberg 2018). Because patients knew their treatment, these self-reports were not blinded.

NETTER-1 patients also kept daily diaries. Compared with their starting point, those on lutetium-177 dotatate reported 4.10 fewer days with abdominal pain, 4.55 fewer with diarrhoea and 4.52 fewer with flushing per 4 weeks, against 0.99, 1.44 and 2.54 fewer days on high-dose octreotide. The differences between groups were 3.11, 3.11 and 1.98 days per 4 weeks, all statistically significant (Strosberg 2021, symptom diaries).

Outside a trial, a Swedish study of 204 people who rated their quality of life before the first and the fourth cycle found improvements in global quality of life, in role, social and emotional functioning, and in several symptoms. The study flagged overweight people who completed four cycles and people over 65 as groups at risk of a worse quality of life during treatment (Edfeldt 2023). This study had no comparison group given another treatment.

For NETTER-2, the primary paper does not report a quality-of-life benefit, and the 2026 commentary describes a quality-of-life benefit as not demonstrated (de Jong 2026).

The Label Warnings

The figures below are as the FDA label states them. "ERASMUS" is a long-running Dutch single-hospital cohort of 1,214 treated people, a subset of whom (811) supplied safety data for the label.

• Radiation exposure: the label states that the drug adds to a person's long-term cumulative radiation exposure, that long-term cumulative radiation exposure is associated with an increased risk for cancer, and that these risks are greater in children than in adults.
• Myelosuppression: in NETTER-1, anaemia occurred in 81% on lutetium-177 dotatate versus 54% on high-dose octreotide; thrombocytopenia (low platelets) in 53% versus 17%, severe in 1% versus 0; neutropenia in 26% versus 11%, severe in 3% versus 0. Platelets reached their lowest point a median of 5.1 months after the first dose; of 59 people with low platelets, 68% recovered to baseline or normal levels, in a median of 2 months.
• Secondary myelodysplastic syndrome and leukaemia: with a median follow-up of 76 months in NETTER-1, myelodysplastic syndrome occurred in 2.3% of the lutetium group and in no one in the octreotide group. In ERASMUS, 16 people (2.0%) developed myelodysplastic syndrome and 4 (0.5%) acute leukaemia. The median time to onset was 29 months (range 9 to 45) for myelodysplastic syndrome and 55 months (range 32 to 125) for acute leukaemia.
• Kidney toxicity: in ERASMUS, 8 people (less than 1%) developed kidney failure 3 to 36 months after treatment. Two of them had earlier kidney impairment or risk factors such as diabetes or high blood pressure and needed dialysis. The label states that people with mild or moderate kidney impairment at the start may be at greater risk because of higher radiation exposure, and that severe kidney impairment has not been studied.
• Liver toxicity: in ERASMUS, 2 people (less than 1%) had bleeding, swelling or tissue death in liver tumours, one with congestion and blocked bile flow in the liver. The label states that people with liver metastases may be at increased risk.
• Hypersensitivity: allergic reactions, including angioedema (swelling under the skin), have occurred.
• Neuroendocrine hormonal crisis: a sudden surge of tumour hormones, with flushing, diarrhoea, bronchospasm (tight airways) and low blood pressure, occurred in less than 1% of people in ERASMUS, typically during or within 24 hours after the first dose. Two people had high blood calcium. The label lists intravenous somatostatin analogs, fluids, corticosteroids and electrolytes as the treatment.
• Embryo-fetal toxicity: based on how it works, the drug can harm an unborn baby. The label calls for effective contraception during treatment and for 7 months after the last dose in women who can become pregnant, and for 4 months in men with female partners who can become pregnant.
• Infertility: the full course gives the testes and ovaries a radiation dose in the range where temporary or permanent infertility is expected after external-beam radiotherapy.

The most common severe side effects that were more frequent on the drug in NETTER-1 were low lymphocytes, raised liver enzymes (GGT, AST and ALT), vomiting, nausea, high blood sugar and low potassium, according to the label.

Long-Term Blood-Cancer and Kidney Risk in Cohort Studies

Trials follow people for a limited time and are small, so most of the long-term picture comes from hospital cohorts. These are observational: they describe what happened to treated people but cannot fully separate the drug's effect from earlier treatments, age and the cancer itself.

• Rotterdam cohort, 2008: in 504 people analysed for toxicity, severe blood toxicity occurred after 3.6% of doses. Myelodysplastic syndrome occurred in 3 people and temporary, non-fatal liver toxicity in 2 (Kwekkeboom 2008).
• Rotterdam cohort, 2017: among 610 people given at least 3.7 GBq, long-term toxicity included acute leukaemia in 4 (0.7%) and myelodysplastic syndrome in 9 (1.5%). No treatment-related long-term kidney or liver failure occurred. In a subgroup of 443 Dutch patients, median progression-free survival was 29 months and overall survival 63 months (Brabander 2017). This was a single-arm cohort, so these survival figures have no comparison group.
• Persistent blood problems: of 274 people with gastroenteropancreatic tumours, 11 (4%) developed a lasting blood disorder. Eight (2.9%) developed a blood cancer or pre-cancer (4 myelodysplastic syndrome, 1 acute myeloid leukaemia, 1 myeloproliferative neoplasm and 2 overlap cases) and 3 (1.1%) developed bone-marrow failure. The median time to diagnosis was 41 months. Compared with Dutch cancer-registry rates, the relative risk was 2.7, with a 95% confidence interval of 0.7 to 10.0, which includes no increase. No risk factor, not even bone metastases or the estimated marrow dose, predicted who was affected (Bergsma 2018).
• Systematic review: 28 studies with 7,334 people treated with receptor-targeted radiation found a mean incidence of therapy-related myeloid neoplasms of 2.61%, varying widely between studies. Of the 134 cases, 32 had chromosome results reported, and the most common finding was a complex pattern consistent with blood cancers that follow radiation or alkylating chemotherapy. The authors describe the risk as small but not insignificant, given the poor outlook once such a cancer appears (Sonbol 2020).
• Clonal hematopoiesis: in a prospective study of 37 people, 35.1% already carried age-related mutations in blood stem cells before treatment. These were linked with lower platelets at the start and more time with low platelets during and after treatment, but whether they predict later blood cancer is not yet known (Kusne 2024).
• Kidneys: of 323 people in the Rotterdam cohort, 3 (1%) had a moderate (grade 2) rise in creatinine and none had severe (grade 3 or 4) kidney toxicity. Kidney function, measured as creatinine clearance, fell by an estimated 3.4% a year on average, and no one lost more than 20% a year. High blood pressure, diabetes and kidney radiation dose did not predict decline (Bergsma 2016).
• Hormonal crises: of 479 people treated in Rotterdam from 2000 to 2007, 6 (1%) developed severe symptoms from a massive hormone release after the first cycle, mostly people with hormone-producing tumours. All recovered with treatment (de Keizer 2008).

Radiation Safety in the Label's Words

The label does not set fixed home rules of its own. It points to hospital radiation-safety practice, federal patient-release guidance and the instructions each patient receives. Its statements are:

• "Radiation can be detected in the urine for up to 30 days following" administration.
• Radiation exposure to "patients, medical personnel, and household contacts" is to be minimised during and after treatment, "consistent with institutional good radiation safety practices, patient management procedures, Nuclear Regulatory Commission patient-release guidance, and instructions to the patient for follow-up radiation protection at home".
• To protect the kidneys and bladder, the label tells clinicians to advise patients "to hydrate and to urinate frequently before, on the day of, and the day after" each dose.
• The label advises against breastfeeding during treatment and for 2.5 months after the last dose, because of the potential risk of serious adverse reactions in a breastfed child.
• Contraception runs for 7 months (women) and 4 months (men with female partners) after the last dose, as listed in the warnings above.

The label also states that more than 99% of the given radioactivity is eliminated within 14 days.

Adolescents Aged 12 to 17

The 2024 approval for children aged 12 and older rests on the adult trial evidence plus safety, blood-level and radiation-dose data from the NETTER-P study, according to the label. NETTER-P enrolled 11 people aged 13 to 17: 4 with gastroenteropancreatic tumours and 7 with pheochromocytoma or paraganglioma. They received the adult schedule of 7.4 GBq every 8 weeks for four cycles.

The most common side effect during treatment was a fall in lymphocytes, in 7 of 11 (64%), severe in 5 of 11 (45%). No treatment-related kidney damage was seen. The projected median radiation dose over four treatments was 21 gray to the kidneys and 0.76 gray to the bone marrow, and blood levels were similar to adults' (Gaze 2025). The label adds that radiation risks are greater in children because of their longer life expectancy and that long-term follow-up is continuing. Safety and effectiveness below age 12 have not been established.

What Is Not Known

• Whether it lengthens life: NETTER-1's final analysis did not show a statistically significant overall-survival gain, and crossover makes the answer harder to reach. NETTER-2's overall-survival results were not in the primary report.
• The best timing: NETTER-2 supports earlier use in higher-grade tumours, but whether giving it first is better than saving it for later has not been tested head to head. A 2022 review notes that data on the order of neuroendocrine treatments are limited (Chauhan 2022).
• The true blood-cancer risk: cohort figures for myelodysplastic syndrome and related blood cancers range from about 1.5% to 2.9%, with wide confidence intervals and no randomized comparison beyond NETTER-1's small numbers. Who is at highest risk is not established (Bergsma 2018; Sonbol 2020).
• Re-treatment: the label covers one course of four doses. The benefit and safety of a second course are not part of the approved label.
• Children: the adolescent data cover 11 people, and lifetime effects in young patients are unknown.
• Tumours outside the gut and pancreas: lung, paraganglioma and other receptor-positive tumours are outside the U.S. indication. The evidence there comes from cohorts and smaller studies.
• Funding: both NETTER trials were funded by the manufacturer, and several authors reported ties to it.

Regulatory Documents

1. U.S. National Library of Medicine, DailyMed. Lutetium Lu 177 dotatate injection: prescribing information (read through the openFDA label record effective January 15, 2026, in November 2026). DailyMed label
2. U.S. Food and Drug Administration, Drugs@FDA. New Drug Application 208700: original approval January 26, 2018, priority review, new molecular entity; efficacy supplement approved April 23, 2024, priority review. Drugs@FDA record
3. ClinicalTrials.gov. NETTER-1, NCT01578239. NCT01578239
4. ClinicalTrials.gov. NETTER-2, NCT03972488. NCT03972488
5. ClinicalTrials.gov. NETTER-P, NCT04711135. NCT04711135

Key Research Papers

1. Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, et al. Phase 3 Trial of (177)Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med. 2017;376(2):125-135. PubMed PMID: 28076709
2. Strosberg JR, Caplin ME, Kunz PL, Ruszniewski PB, Bodei L, Hendifar A, et al. (177)Lu-Dotatate plus long-acting octreotide versus high-dose long-acting octreotide in patients with midgut neuroendocrine tumours (NETTER-1): final overall survival and long-term safety results from an open-label, randomised, controlled, phase 3 trial. Lancet Oncol. 2021;22(12):1752-1763. PubMed PMID: 34793718
3. Singh S, Halperin D, Myrehaug S, Herrmann K, Pavel M, Kunz PL, et al. [(177)Lu]Lu-DOTA-TATE plus long-acting octreotide versus high-dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2-3, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study. Lancet. 2024;403(10446):2807-2817. PubMed PMID: 38851203
4. Strosberg J, Wolin E, Chasen B, Kulke M, Bushnell D, Caplin M, et al. Health-Related Quality of Life in Patients With Progressive Midgut Neuroendocrine Tumors Treated With (177)Lu-Dotatate in the Phase III NETTER-1 Trial. J Clin Oncol. 2018;36(25):2578-2584. PubMed PMID: 29878866
5. Strosberg JR, Srirajaskanthan R, El-Haddad G, Wolin EM, Chasen BA, Kulke MH, et al. Symptom Diaries of Patients with Midgut Neuroendocrine Tumors Treated with (177)Lu-DOTATATE. J Nucl Med. 2021;62(12):1712-1718. PubMed PMID: 33771903
6. Gaze MN, Handkiewicz-Junak D, Hladun R, Laetsch TW, Sorge C, Sparks R, et al. Safety and dosimetry of [(177)Lu]Lu-DOTA-TATE in adolescent patients with somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumours, or pheochromocytomas and paragangliomas: Primary analysis of the Phase II NETTER-P study. Eur J Nucl Med Mol Imaging. 2025;52(11):4001-4015. PubMed PMID: 40198358
7. Kwekkeboom DJ, de Herder WW, Kam BL, van Eijck CH, van Essen M, Kooij PP, et al. Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0,Tyr3]octreotate: toxicity, efficacy, and survival. J Clin Oncol. 2008;26(13):2124-30. PubMed PMID: 18445841
8. Brabander T, van der Zwan WA, Teunissen JJM, Kam BLR, Feelders RA, de Herder WW, et al. Long-Term Efficacy, Survival, and Safety of [(177)Lu-DOTA(0),Tyr(3)]octreotate in Patients with Gastroenteropancreatic and Bronchial Neuroendocrine Tumors. Clin Cancer Res. 2017;23(16):4617-4624. PubMed PMID: 28428192
9. Bergsma H, van Lom K, Raaijmakers MHGP, Konijnenberg M, Kam BLBLR, Teunissen JJM, et al. Persistent Hematologic Dysfunction after Peptide Receptor Radionuclide Therapy with (177)Lu-DOTATATE: Incidence, Course, and Predicting Factors in Patients with Gastroenteropancreatic Neuroendocrine Tumors. J Nucl Med. 2018;59(3):452-458. PubMed PMID: 28775205
10. Bergsma H, Konijnenberg MW, van der Zwan WA, Kam BL, Teunissen JJ, Kooij PP, et al. Nephrotoxicity after PRRT with (177)Lu-DOTA-octreotate. Eur J Nucl Med Mol Imaging. 2016;43(10):1802-11. PubMed PMID: 27160225
11. Sonbol MB, Halfdanarson TR, Hilal T. Assessment of Therapy-Related Myeloid Neoplasms in Patients With Neuroendocrine Tumors After Peptide Receptor Radionuclide Therapy: A Systematic Review. JAMA Oncol. 2020;6(7):1086-1092. PubMed PMID: 32297906
12. Kusne Y, Lasho T, Finke C, Elsabbagh Z, McCue S, Hobday T, et al. Clonal Hematopoiesis in Patients With Neuroendocrine Tumor Treated With Lutetium-177 and the Risk of Thrombocytopenia: A Prospective Study. JCO Precis Oncol. 2024;8:e2400143. PubMed PMID: 38976813
13. de Keizer B, van Aken MO, Feelders RA, de Herder WW, Kam BL, van Essen M, et al. Hormonal crises following receptor radionuclide therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate. Eur J Nucl Med Mol Imaging. 2008;35(4):749-55. PubMed PMID: 18210106
14. Edfeldt K, Hellman P, Granberg D, Lagergren P, Thiis-Evensen E, Sundin A, et al. Improved health-related quality of life during peptide receptor radionuclide therapy in patients with neuroendocrine tumours. J Neuroendocrinol. 2023;35(10):e13342. PubMed PMID: 37807573
15. Deppen SA, Liu E, Blume JD, Clanton J, Shi C, Jones-Jackson LB, et al. Safety and Efficacy of 68Ga-DOTATATE PET/CT for Diagnosis, Staging, and Treatment Management of Neuroendocrine Tumors. J Nucl Med. 2016;57(5):708-14. PubMed PMID: 26769865
16. Delpassand ES, Ranganathan D, Wagh N, Shafie A, Gaber A, Abbasi A, et al. (64)Cu-DOTATATE PET/CT for Imaging Patients with Known or Suspected Somatostatin Receptor-Positive Neuroendocrine Tumors: Results of the First U.S. Prospective, Reader-Masked Clinical Trial. J Nucl Med. 2020;61(6):890-896. PubMed PMID: 31924723
17. Becx MN, Minczeles NS, Brabander T, de Herder WW, Nonnekens J, Hofland J. A Clinical Guide to Peptide Receptor Radionuclide Therapy with (177)Lu-DOTATATE in Neuroendocrine Tumor Patients. Cancers (Basel). 2022;14(23):5792. PubMed PMID: 36497273
18. Chauhan A, Del Rivero J, Ramirez RA, Soares HP, Li D. Treatment Sequencing Strategies in Advanced Neuroendocrine Tumors: A Review. Cancers (Basel). 2022;14(21):5248. PubMed PMID: 36358667
19. de Jong F, Douma LH, Baas P, de Gooijer CJ, Gelderblom H, Burgers JA, et al. Critical appraisal of combination therapies: the impact of trial design on Benefit-Risk outcomes. J Natl Cancer Inst. 2026 (online ahead of print):djag343. PubMed PMID: 42786595

PubMed Topic Searches

1. PubMed: lutetium-177 dotatate in neuroendocrine tumours
2. PubMed: receptor-targeted radiation therapy and myelodysplastic syndrome
3. PubMed: lutetium-177 dotatate and kidney toxicity
4. PubMed: NETTER-2

Connections

• Drugs — every drug page on the site
• Neuroendocrine Tumors — the tumours this drug treats, their grades and other treatments
• Carcinoid Tumor — the older name for many gut and lung neuroendocrine tumours
• Paraganglioma — another receptor-positive tumour where dotatate scans are used
• Myelodysplastic Syndrome — the bone-marrow disorder listed among the late risks
• Tumor Markers — chromogranin A and other blood tests used in these tumours
• Guillemin and Schally — the scientists behind somatostatin, the hormone this drug imitates
• Lysine — one of the two amino acids infused to protect the kidneys

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