# NETTER-1: 177Lu-Dotatate for midgut neuroendocrine tumours progressing on octreotide

Source: https://nuclide.cc/key-papers/paper-netter-1-nejm-2017/  
Nuclide record `paper-netter-1-nejm-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

Radioligand therapy with lutetium-177 dotatate reduced the risk of progression or death by nearly 80 percent compared with high-dose octreotide in midgut neuroendocrine tumours, the first randomised proof that targeted radiation works in these cancers.

## Summary

Phase 3 trial of 229 patients with advanced, progressive, somatostatin receptor-positive midgut neuroendocrine tumours randomised to four cycles of 177Lu-Dotatate plus octreotide LAR 30 mg or high-dose octreotide LAR 60 mg.

Progression-free survival at 20 months was 65.2 versus 10.8 percent (hazard ratio 0.21), response 18 versus 3 percent, and an interim analysis suggested improved overall survival; myelosuppression was modest.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2017
- DOI: 10.1056/NEJMoa1607427
- Authors: Strosberg J, El-Haddad G, Wolin E, et al.
- Findings: Progression-free survival hazard ratio 0.21; 20-month rate 65.2 percent vs 10.8 percent.; Objective response 18 percent vs 3 percent.
- What it means: Lutetium-177 dotatate is a standard treatment for progressive small bowel neuroendocrine tumours after somatostatin analogues, and NETTER-2 has since moved it into first-line use for higher-grade tumours.
- Caveats: Final overall survival difference (48.0 vs 36.3 months) did not reach significance, partly because of crossover.; Rare late myelodysplasia and leukaemia.

## Sources

- N Engl J Med 2017: https://doi.org/10.1056/NEJMoa1607427
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28076709/

## Connected records

- isotopes: [Lutetium-177](https://nuclide.cc/isotopes/lu-177/)
- indications: [Small intestinal neuroendocrine tumours](https://nuclide.cc/indications/small-intestinal-net/)
- trials: [NETTER-1](https://nuclide.cc/trials/netter-1/)
- journals: [New England Journal of Medicine](https://nuclide.cc/journals/nejm/)
- fronts: [Radioligand therapy](https://nuclide.cc/fronts/f-radioligand-therapy/)
- key papers: [Health-related quality of life in the NETTER-1 trial of 177Lu-Dotatate](https://nuclide.cc/key-papers/paper-strosberg-netter1-qol-jco-2018/), [Results and adverse events of personalised peptide receptor radionuclide therapy in 1048 patients with neuroendocrine neoplasms](https://nuclide.cc/key-papers/paper-baum-prrt-1048-patients-oncotarget-2018/)
- roadmaps: [SSTR theranostics roadmap: octreotide scintigraphy → 68Ga-DOTATATE → 177Lu-DOTATATE → alpha](https://nuclide.cc/roadmaps/sstr-theranostics-roadmap/)

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