# NETTER-1: 177Lu-Dotatate for midgut neuroendocrine tumours progressing on octreotide

Source: https://onco.cc/key-papers/paper-netter-1-nejm-2017/  
OnCo record `paper-netter-1-nejm-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radioligand therapy with lutetium-177 dotatate reduced the risk of progression or death by nearly 80 percent compared with high-dose octreotide in midgut neuroendocrine tumours, the first randomised proof that targeted radiation works in these cancers.

## Summary

Phase 3 trial of 229 patients with advanced, progressive, somatostatin receptor-positive midgut neuroendocrine tumours randomised to four cycles of 177Lu-Dotatate plus octreotide LAR 30 mg or high-dose octreotide LAR 60 mg.

Progression-free survival at 20 months was 65.2 versus 10.8 percent (hazard ratio 0.21), response 18 versus 3 percent, and an interim analysis suggested improved overall survival; myelosuppression was modest.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2017
- DOI: 10.1056/NEJMoa1607427
- Authors: Strosberg J, El-Haddad G, Wolin E, et al.
- Findings: Progression-free survival hazard ratio 0.21; 20-month rate 65.2 percent vs 10.8 percent.; Objective response 18 percent vs 3 percent.
- What it means: Lutetium-177 dotatate is a standard treatment for progressive small bowel neuroendocrine tumours after somatostatin analogues, and NETTER-2 has since moved it into first-line use for higher-grade tumours.
- Caveats: Final overall survival difference (48.0 vs 36.3 months) did not reach significance, partly because of crossover.; Rare late myelodysplasia and leukaemia.

## Sources

- N Engl J Med 2017: https://doi.org/10.1056/NEJMoa1607427
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28076709/

## Connected records

- cancers: [Small intestinal neuroendocrine tumours](https://onco.cc/cancers/small-intestinal-net/)
- trials: [NETTER-1](https://onco.cc/trials/netter-1/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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