Miscellaneous: Neuroendocrine tumour: PRRT (NETTER-1)
Free question published 09 August 2026
A 63-year-old woman has a well-differentiated, grade 2 metastatic midgut neuroendocrine tumour with somatostatin-receptor-positive liver metastases on 68Ga-DOTATATE PET-CT. Her disease has progressed radiologically on octreotide LAR 30 mg every 4 weeks. Performance status is 1 and renal function is adequate. Which treatment offers the greatest improvement in progression-free survival?
- AStreptozocin and 5-fluorouracil combination systemic cytotoxic chemotherapy
- BInterferon alfa monotherapy
- CPeptide receptor radionuclide therapy with 177Lu-DOTATATE
- DIncrease octreotide LAR to 60 mg every 4 weeks
- EExternal beam radiotherapy directed specifically to the somatostatin-receptor-positive liver metastases
Why C is correct
NETTER-1 randomised patients with progressive, somatostatin-receptor-positive midgut neuroendocrine tumours to 177Lu-DOTATATE (7.4 GBq every 8 weeks for four cycles) versus high-dose octreotide LAR 60 mg every 4 weeks. Progression-free survival at month 20 was 65.2% with 177Lu-DOTATATE versus 10.8% with high-dose octreotide, with a higher response rate (18% versus 3%). NICE TA539 now recommends lutetium (177Lu) oxodotreotide within its marketing authorisation for exactly this somatostatin-receptor-positive, progressive, well-differentiated setting, making PRRT the current NHS-funded, evidence-based choice.
And why the others are not
- AStreptozocin-based chemotherapy is more relevant to pancreatic NET; it is not the evidence-based option for progressive midgut NET that is receptor-positive.
- BInterferon alfa has limited activity and is not the guideline-supported choice over PRRT in this setting.
- DHigh-dose octreotide LAR 60 mg was the comparator arm in NETTER-1 and was markedly inferior to 177Lu-DOTATATE for progression-free survival.
- EExternal beam radiotherapy is not a standard systemic option for diffuse somatostatin-receptor-positive metastatic midgut NET.
Source NETTER-1 - Phase 3 trial of 177Lu-DOTATATE for midgut neuroendocrine tumours — Strosberg J, El-Haddad G, Wolin E, et al. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med. 2017;376(2):125-135.
More free miscellaneous questions
2,500+ cited questions like this one are waiting in the vault.
See plans and pricing