Ronny Allan
Brief Summary
The NETTER-1 trials led to the approval of Lu177 (or Lutathera), more commonly known in the community as Peptide Receptor Radio Therapy (PRRT). This led to an explosion of availability across the world but many gaps in service remain.
Many PRRT spin off trials are in the pipeline looking at different types of PRRT, mainly using slightly different radionuclides and techniques. However, NETTER-2 builds on the success of the approved version formally known as Lutathera.
The aim of NETTER-2 is to determine if Lutathera in combination with long-acting octreotide prolongs PFS in GEP-NET patients with high proliferation rate tumors (G2 and G3), when given as a first line treatment compared to treatment with high dose (60 mg) long-acting octreotide. Somatostatin analog (SSA) naive patients are eligible, as well as patients previously treated with SSAs in the absence of progression. This is a phase 3 trial that will be hoping for 222 participants at multiple locations.
This is an exciting trial because there are already data produced indicating that PRRT can be used on high grade tumours providing they have sufficient and efficient somatostatin receptors and a Ki67 of less than 55%. 2019 Updated data for Grade 3 Neuroendocrine Neoplasms: “Compared to studies evaluating the efficacy of chemotherapy for NEN patients with a Ki-67 index less than or equal to 55 percent, PRRT has a longer overall survival rate–22 months versus 14 months,” the researchers pointed out. “These results suggest that PRRT, rather than chemotherapy, may be a superior first-line therapeutic option in selected patients with a high level of SSTR expression and a Ki-67 index of less than or equal to 55%.” Read more here.
The trial is taking place in USA (Texas), UK, Italy, Spain and France. The first patient was treated in March 2020 (click here to see this update). Important to read the criteria section if this trial interests you. Clinical Trials document here.
In the meantime, read more about Lutathera (PRRT) by clicking here.
This looks like a very exciting development.
Clinical Trials Disclaimer
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided in the clinical trials document. It’s very important to check the trial inclusion and exclusion criteria before making any contact.
Inclusion of any trial within this blog should not be taken as a recommendation by Ronny Allan.
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Hi Ronny a concern of the NETTER 2 trial by leading experts is that they would never give 60mg octreotide to G3 patients as first line treatment. For this trial to be ethical and really have a comparative arm it should compare PRRT with standard of care which is Chemotherapy. It may be very hard to recruit to ethically?
Not heard that but will keep a look out, do you have and documents saying that?
Bear in mind its G3 well differentiated less than 55% Ki67
Very encouraging 👍
Hi Ronny
Just an update. Spoke to my NET nurse and UHCW at Coventry are now able to offer PRRT, so perhaps you could check this is correct and add to the UK list. Cheers.