Radioligand Therapy and Sequencing in Gastroenteropancreatic Neuroendocrine Tumors: A Patient Perspective Review

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are the most frequent subtype of NETs and their incidence has steadily increased over the past few decades. Patients with GEP-NETs often experience a large symptom burden and decrease in quality of life. Delays in diagnosis and high incidence of metastatic disease are the consequences of a lack of awareness or a lack of understanding of how to manage GEP-NETs among health care professionals. Although surgical resection is the only curative approach for GEP-NETs, many patients are not candidates for surgery. For these patients, new therapies have emerged recently, including radiolabeled therapeutic peptides used to target cancer cells and inhibit tumor growth. Radiolabeled somatostatin analogs, such as [¹⁷⁷Lu]Lu-DOTA-TATE (¹⁷⁷Lu-DOTATATE), are often used in radioligand therapy (RLT). ¹⁷⁷Lu-DOTATATE has been approved for the treatment of advanced GEP-NETs and has demonstrated efficacy and safety in clinical trials as well as in real-world studies. With the emergence of RLT for the management of GEP-NETs, treatment sequencing is of increasing importance. Considering the perspectives of patients with GEP-NETs on using RLT in their treatment journey is not only key to understanding and allaying their concerns regarding the safety of RLT but is also important in helping to identify patient priorities of treatment attributes. This review aims to identify the factors influencing patients considering RLT, their perceptions regarding treatment sequence options, the barriers in RLT access, and the disparities (eg, racial, geographical) among patients with GEP-NETs in accessing care.