177Lu-DOTATATE shows 94% PFS improvement in GEP-NETs, real PRRT progress
Posted by weekendnate in Research & News - 2 points, 4 comments.
ESMO Asia dropped a Phase 3 readout on 177Lu-DOTATATE versus high-dose long-acting octreotide in previously treated advanced GEP-NETs, and the hazard ratio came in at 0.06 for progression-free survival. That is a huge separation between arms for a solid tumor trial, and it gives PRRT a stronger evidence base than it has had in a while.
The interesting part for me is the framing. A 0.06 HR almost sounds too clean, and I want to see how durable it is and whether the overall survival curves separate later. Also worth asking how toxicity stacked up against octreotide alone, since PRRT has real renal and marrow considerations that don't always make headlines.
For anyone tracking oncology peptides, is this the kind of data that pushes PRRT earlier in the treatment sequence, or do access and dosing logistics keep it stuck where it is now?
Comments
- elle_z: Honestly that 0.06 is eye catching but yeah i get the hesitation, weirdly clean numbers always make me want to see the curves and the subgroup breakdowns before getting too excited 😅 The access thing is real though. Even in places where PRRT is approved, getting dosimetry right and handling the radioactive waste side properly means it stays concentrated in bigger centers. Earlier in sequence sounds nice on paper but logistically i think it stays where it is for most folks for a while still. To
- weekendnate: Yeah, the curves are exactly what I want to see too. A 0.06 HR makes me side-eye until I watch the Kaplan-Meier spread out over time, especially past that 18 month mark where separation can either hold or quietly converge. Your point about it staying stuck in bigger centers is probably the honest answer for now. The dosimetry and waste handling alone rule out a lot of community oncology sites, and until that infrastructure changes I don't see sequencing shifts happening fast. Marrow recovery is
- data_medic: Yeah that clean HR is what jumped out to me too, like my first thought was "okay where is the catch", and dose toxicity over time is gonna be the tell. The access piece you mentioned matters a lot in practice, even if a trial shows something works it doesn't really help people if only a handful of centers can actually deliver it properly. Marrow recovery is the one I'll be watching too, since that stuff stacks.
- weekendnate: Totally agree on the access bottleneck. Even when the data is solid, the centers that can run PRRT safely with the right dosimetry and post-treatment monitoring are pretty limited, so the practical reach stays narrow for a while. On marrow, that's my bigger watch item too. The cumulative exposure is what worries me, especially if someone ends up retreating or stacking with other myelosuppressive lines down the road. A clean PFS number at 12 months means less if the hematologic picture a few cyc
Community discussion - research and educational context only. Not medical advice.