There can be no doubt that the discovery of somatostatin receptors as a means to treat Neuroendocrine Tumours has been a huge success. Additionally, scientists looked at a theranostic angle and provided somatostatin receptor based imaging for diagnosis and surveillance purposes.
Many patients are prescribed somatostatin anlaogues shortly after diagnosis and this has led to a reduction in the morbidity that comes from active carcinoid syndrome and has reduced the incidence of carcinoid heart disease.
More recently, the introduction of somatostatin receptor based PETs, taking over from the elderly Octreotide scans, has meant speedier and higher quality identification of NETs leading to more focussed treatment. Moreover, the use of somatostatin receptor based therapy via radioligands (e.g. Ga68 PET/Cu64 PET) is nothing short of a theraputic revolution now being introduced into other cancers using targeted entry points specifric to those cancers. NETs were at the forefront of this revolution for many years. Add in the use of Alpha-emitter radioligands and the excitement levels increase, albeit this is currently an investigatory option still in clinical trials.
But one issue still remains unclear. When to deploy this therapy approach? i.e. Sequencing of treatment for somatostatin receptor positive NETs.
If you put lots of experts in a room, expect lots of different opinions. But what matters is they eventually come to a consensus, thus why you will see guidelines described using words such as “the consensus view” or “consensus guidelines” etc.
I came across this review paper written by some big names in the NET world in US and was published in January 2024. It is focussed on the sequencing of treatment using somatostatin based therapies, i.e. using somatostatin analogues (SSA) and Peptide Receptor Radionuclide Therapy (PRRT). It also touches on what remains a key question in management of patients with gastroenteropancreatic and lung NETs is the sequencing of 177Lu-DOTATATE in relation to other systemic treatments such as everolimus, chemotherapy and liver-directed therapies. This question is particularly complicated given the heterogeneity of NETs and the near absence of randomised trials comparing active treatment options. This state-of-the-art review examines the evidence supporting use of somatostatin-receptor–targeted treatments within the larger landscape of NET therapy and offers insights regarding optimal patient selection, assessment of benefit versus risk, and treatment sequencing.
The timing of this paper is interesting because it almost coincides with the big announcement from Novartis which suggests using PRRT as a first line treatment alongside SSA using evidence from the clinical trial NETTER-2. You would be excused for pointing out that NETTER-1 was mainly midgut grade 1 well differentiated NET patients whereas NETTER-2 was exclusivley grade 2 and 3 well differentiated NETs and included pancreatic NETs, hinting that comparing the two trials is not the best comparison. Or to quote one NET specialist online, “As many of my colleagues have observed, NETTER-1 & 2 enrolled different NET populations (former midgut only, the latter midgut & PNET; former 66% grade 1/34% grade 2; the latter all grade 2/3)”.
I leave you to read this excellent review paper (it has many mini-primers which alone are useful) and if you’re not temtped by my intro, I’ve also listed the section headlines below.
I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me.
Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional. Some content may be generated by AI which can sometimes be misinterpreted. Please check any references attached.
Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.
Thanks for reading.
Blog Facebook. Like this page please.
Personal Facebook. Like this page please.
Awareness Facebook Like this page please.
Follow me on X (formerly twitter)
Check out my online presentations
Check out my WEGO Health Awards
Vitamin D deficiency is demonstrably more common in people with neuroendocrine tumours (NETs) — but that does not automatically mean your deficiency is caused by
Words are very important to cancer patients, some people hang their hats on them and put their feet up, and some people google them until
Overview Many thanks for the support in January and February 2026. This is a double month newsletter due to my 27 day holiday! 2026 Blog
Vitamin B12 deficiency is demonstrably more common in people with neuroendocrine tumours (NETs) – what that means is there is a chance your deficiency as
When I was a young lad, I didn’t seem to have a fear of heights, not that I got many chances to test it but
When I was diagnosed with metastatic Neuroendocrine Cancer in 2010, there’s a lot of milestones I doubted I would reach. One is today and I
A Phase 2/3, Multicenter, Randomized Open-Label Study of Zanzalintinib vs Everolimus in Participants With Previously Treated, Unresectable, Locally Advanced or Metastatic Neuroendocrine Tumors. The primary purpose
Long-axial field-of-view (LAFOV) systems have changed the field of molecular imaging. Since their introduction, many PET centres have installed these next-generation digital systems to provide
Crinetics Announces First Patient Dosed in Phase 1/2 Trial Evaluating CRN09682 for the Treatment of Neuroendocrine Tumours and Other Somatostatin Receptor 2-Expressing Tumours Read the
I would also mention those who contributed to my “Tea Fund” which resides on PayPal. You don’t need a PayPal account as you can select a card but don’t forget to select the number of units first (i.e. 1 = £4, 2 = £8, 3 = £12, and so on), plus further on, tick a button to NOT create a PayPal account if you don’t need one. Clearly, if you have a PayPal account, the process is much simpler
Through your generosity, I am able to keep my sites running and provide various services for you. I have some ideas for 2023 but they are not detailed enough to make announcements yet.
This screenshot is from every single post on my website and depending on which machine you are using, it will either be top right of the post or at the bottom (my posts are often long, so scroll down!)
Subscribe to get the latest posts sent to your email.
