PRRT Treatment - Peptide Receptor Radionuclide Therapy
PRRT, peptide receptor radionuclide therapy, treats neuroendocrine tumors that have spread by delivering lutetium-177 radiation through the somatostatin receptors on tumor cells, using Lu-177 DOTATATE (Lutathera). Four infusions are given eight weeks apart after a Ga-68 DOTATATE PET scan confirms the receptors. Our nuclear medicine team plans each cycle around your somatostatin injections and follows you once you are back home.
About This Department
Most neuroendocrine tumors carry receptors for the hormone somatostatin. PRRT uses those receptors to deliver radiation from inside.
PRRT, peptide receptor radionuclide therapy, treats neuroendocrine tumors that have spread or cannot be removed by linking a somatostatin-like peptide to the radioactive metal lutetium-177, in the drug Lu-177 DOTATATE, sold as Lutathera. The peptide finds the somatostatin receptors on tumor cells and the lutetium irradiates them over the following days. A course has four infusions, eight weeks apart. In the NETTER-1 trial of midgut neuroendocrine tumors growing on standard treatment, 65.2 percent of patients on PRRT were alive without progression at 20 months, against 10.8 percent on high-dose octreotide (Strosberg and colleagues, New England Journal of Medicine, 2017). As a first treatment for grade 2 and 3 tumors, it extended median progression-free survival from 8.5 to 22.8 months (Singh and colleagues, Lancet, 2024). A Ga-68 DOTATATE PET/CT scan first confirms the receptors are there. This page explains how PRRT works, who qualifies, the scan that selects patients, trial results, a treatment day, side effects, precautions at home, follow-up, and how patients from abroad arrange PRRT at Biruni Hospital in Istanbul.
What PRRT is
| Tumor | Origin | Evidence |
|---|---|---|
| Midgut neuroendocrine tumor | Small bowel, appendix, right colon | Randomized trial, NETTER-1 |
| Pancreatic neuroendocrine tumor | Pancreas | Large series, NETTER-2 included |
| Grade 2 and 3 gastroenteropancreatic tumors | Gut and pancreas | Randomized first-line trial, NETTER-2 |
| Lung carcinoid, paraganglioma, pheochromocytoma | Lungs, nerve tissue | Case series, selected patients |
Theranostics
The same receptor seen on the DOTATATE PET scan becomes the target of treatment. What lights up on the scan is what the therapy will reach.
Who qualifies
| Requirement | Why | How checked |
|---|---|---|
| Well-differentiated tumor, grade 1 to 3 | Carries receptors and responds | Pathology with Ki-67 |
| Strong somatostatin receptor uptake | The drug needs the target | Ga-68 DOTATATE PET/CT |
| Adequate kidney function | The drug leaves through the kidneys | Blood tests, kidney scan if needed |
| Adequate blood counts and liver function | Marrow and liver tolerance | Blood tests |
Poorly differentiated neuroendocrine carcinoma, which behaves more like other aggressive cancers, is treated with chemotherapy rather than PRRT.
The scan that selects patients
Ga-68 DOTATATE PET/CT shows where somatostatin receptors are and how many. Uptake stronger than the normal liver predicts benefit from PRRT.
| Score | Uptake compared with normal organs | Suitability |
|---|---|---|
| 1 | Very low | Not suitable |
| 2 | Equal to liver | Borderline |
| 3 | Greater than liver | Suitable |
| 4 | Greater than spleen or kidneys | Most suitable |
Why the receptor matters
No receptor, no effect.
PRRT works only as well as the uptake it achieves, so the selection scan carries great weight. A tumor whose every deposit glows brighter than the liver on DOTATATE PET receives a high radiation dose with little spillover to healthy tissue, while one with patchy or weak uptake receives too little to matter and exposes the patient to side effects without much chance of benefit. That single image, read carefully by experienced physicians, decides more about the outcome than any other factor we can measure before treatment.
Grade matters too. Faster-growing tumors lose receptors over time.
Results in midgut tumors
Treatment with Lu-Dotatate resulted in markedly longer progression-free survival and a significantly higher response rate than high-dose octreotide LAR among patients with advanced midgut neuroendocrine tumors (Strosberg and colleagues, 2017).
| Measure | PRRT with octreotide | High-dose octreotide |
|---|---|---|
| Alive without progression at 20 months | 65.2 percent | 10.8 percent |
| Tumor shrinkage | 18 percent | 3 percent |
| Median overall survival, final analysis | 48.0 months | 36.3 months |
PRRT as a first treatment
First-line Lu-Dotatate plus octreotide LAR significantly extended median progression-free survival by 14 months in patients with grade 2 or 3 advanced gastroenteropancreatic neuroendocrine tumors (Singh and colleagues, 2024).
| Measure | PRRT with octreotide | High-dose octreotide |
|---|---|---|
| Median progression-free survival | 22.8 months | 8.5 months |
| Treatment-related deaths | None | None |
A treatment day
A scan the day after the infusion shows where the drug has gone and confirms it reached the tumors.
Schedule
| Step | Timing | Note |
|---|---|---|
| Stop long-acting somatostatin analog | 4 weeks before each cycle | Short-acting injections until 24 hours before |
| Infusion day | Day 1 of each cycle | Amino acids and Lu-177 DOTATATE |
| Post-treatment scan | Day 2 | Discharge with precautions |
| Blood tests | Every 2 to 4 weeks | Counts, kidney and liver |
| Next cycle | 8 weeks later | Four cycles in total |
Somatostatin analog injections
Do I have to stop my octreotide or lanreotide injections?
Living with a neuroendocrine tumor
Many patients live with the disease for years. Some for decades.
Neuroendocrine tumors grow slowly in the majority, and even with spread to the liver, patients may work and live full lives for a long time. The aim of treatment is control, of the tumor and of symptoms such as flushing and diarrhea, for as long as possible, choosing each step so that later options remain open. PRRT fits into that plan alongside injections, surgery, liver-directed treatment and targeted drugs.
Side effects
- Nausea and vomiting on the day of treatment, mostly from the amino acid infusion.
- Tiredness and reduced appetite for a few days.
- Temporary hair thinning in some patients, without full hair loss.
| Side effect | How often | What helps |
|---|---|---|
| Nausea, vomiting | Common on treatment day | Anti-sickness medicine before the infusion |
| Low blood counts | Serious in a small minority | Blood tests, delay or dose reduction |
| Kidney changes | Rare with amino acid protection | Monitoring of kidney function |
| Hormone flare | Uncommon | Short-acting octreotide, extra fluids |
In the long-term follow-up of NETTER-1, 2 percent of patients treated with PRRT developed myelodysplastic syndrome, a bone marrow disorder, and blood counts are therefore followed for years.
Precautions at home
| Precaution | Usual duration | Note |
|---|---|---|
| Distance from children and pregnant women | About one week | Brief contact is fine |
| Separate bed | About one week | Varies with dose and national rules |
| Contraception | Several months after the last cycle | For men and women |
Follow-up and retreatment
| Test | Timing | Purpose |
|---|---|---|
| Blood tests | Every 2 to 4 weeks during treatment, then every 3 months | Counts, kidney and liver function |
| CT or MRI | About 3 months after the last cycle, then regularly | Tumor size |
| DOTATATE PET/CT | As needed | Receptor status before any retreatment |
For patients from abroad
Before you travel
Your coordinator
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Cost
What a quote covers
| Item | Included | Priced separately |
|---|---|---|
| Treatment | Lu-177 DOTATATE, amino acid infusion, shielded room stay | Extra nights for medical reasons |
| Imaging | Post-treatment scan | Ga-68 DOTATATE PET/CT before and after the course |
| Tests and review | Blood tests on treatment days, nuclear medicine review | Somatostatin analog injections |
PRRT is priced per cycle, and a standard course has four cycles.
References
- 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.
- Strosberg JR, Caplin ME, Kunz PL, et al. 177Lu-Dotatate plus long-acting octreotide versus high-dose long-acting octreotide in patients with midgut neuroendocrine tumours (NETTER-1). Final overall survival and long-term safety results from an open-label, randomised, controlled, phase 3 trial. Lancet Oncol. 2021;22(12):1752-1763.
- Singh S, Halperin D, Myrehaug S, et al. [177Lu]Lu-DOTA-TATE plus long-acting octreotide versus high-dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2-3, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2). An open-label, randomised, phase 3 study. Lancet. 2024;403(10446):2807-2817.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Specialist Dr. Nesrin Aslan İlkmen, Nuclear Medicine.
Medically reviewed by
Specialist Dr. Nesrin Aslan İlkmen
Nuclear Medicine
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