Treatment of lung neuroendocrine tumors with ¹⁷⁷Lu-DOTATATE: Experience from a Tertiary Oncology Center

Evidence from randomized control trials supporting peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu DOTATATE in patients with lung neuroendocrine tumors (NETs) is limited. Real world data is needed.

We conducted a retrospective cohort study of patients with metastatic or unresectable lung carcinoid tumors treated with [177Lu]Lu-DOTATATE at a single Tertiary Oncology Center. Radiographic response (objective response rate - ORR; disease control rate - DCR), progression-free survival (PFS), overall survival (OS) and treatment toxicity (CTCAE v4) were assessed. Exploratory univariate Cox regression analyses were performed to evaluate predictors of PFS and OS.

Twenty-two patients were included. The ORR was 31.8%, with DCR of 63.6%. Median PFS was 19 months (95% CI, 10-28), and median OS was 46 months (95% CI, 38-53). No grade 3/4 toxicities were observed. Symptom improvement was reported in 35.7% of symptomatic patients. Prior treatment with somatostatin analogues was significantly associated with longer PFS (HR 0.18, 95% CI, 0.05-0.62, p = 0.007), while respiratory symptoms were associated with shorter PFS (HR 5.01, 95% CI, 1.44-17.87, p = 0.012).

PRRT with [177Lu]Lu-DOTATATE appears to be safe and effective for patients with advanced lung carcinoids. These findings support PRRT as a valuable treatment option in selected patients, while highlighting the urgent need for prospective trials to establish its role in lung NETs.