{"entity":{"id":"paper-netter-1-nejm-2017","kind":"paper","name":"NETTER-1: 177Lu-Dotatate for midgut neuroendocrine tumours progressing on octreotide","aka":[],"tldr":"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.\n\nProgression-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.","asOf":"2026-09-17","links":[{"label":"N Engl J Med 2017","url":"https://doi.org/10.1056/NEJMoa1607427"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/28076709/"}],"tags":[],"related":["lu-177"],"indications":["small-intestinal-net"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["netter-1"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2017,"doi":"10.1056/NEJMoa1607427","pmid":"28076709","authors":"Strosberg J, El-Haddad G, Wolin E, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":229},"route":"/key-papers/paper-netter-1-nejm-2017/","neighbours":{"isotope":[{"id":"lu-177","kind":"isotope","name":"Lutetium-177","route":"/isotopes/lu-177/"}],"indication":[{"id":"small-intestinal-net","kind":"indication","name":"Small intestinal neuroendocrine tumours","route":"/indications/small-intestinal-net/"}],"trial":[{"id":"netter-1","kind":"trial","name":"NETTER-1","route":"/trials/netter-1/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"section":[{"id":"f-radioligand-therapy","kind":"section","name":"Radioligand therapy","route":"/fronts/f-radioligand-therapy/"}],"paper":[{"id":"paper-strosberg-netter1-qol-jco-2018","kind":"paper","name":"Health-related quality of life in the NETTER-1 trial of 177Lu-Dotatate","route":"/key-papers/paper-strosberg-netter1-qol-jco-2018/"},{"id":"paper-baum-prrt-1048-patients-oncotarget-2018","kind":"paper","name":"Results and adverse events of personalised peptide receptor radionuclide therapy in 1048 patients with neuroendocrine neoplasms","route":"/key-papers/paper-baum-prrt-1048-patients-oncotarget-2018/"}],"roadmap":[{"id":"sstr-theranostics-roadmap","kind":"roadmap","name":"SSTR theranostics roadmap: octreotide scintigraphy → 68Ga-DOTATATE → 177Lu-DOTATATE → alpha","route":"/roadmaps/sstr-theranostics-roadmap/"}]}}