Alpha Before Beta

Abstract

Abstract The utility of β-emitter 177 Lu-DOTATATE in patients of neuroendocrine tumors (NETs) with widespread skeletal metastases is limited by its relatively modest response rates and a significant concern for hematotoxicity. In such situations, targeted α therapy with 225 Ac-DOTATATE can be potentially beneficial. In this report, a 46-year-old man with rectal NET and extensive skeletal metastases was treated upfront with 6 cycles of 225 Ac-DOTATATE at 8 weeks’ intervals. The patient showed excellent symptomatic, biochemical, and radiological response with no grade 3/4 adverse events. The first-line use of 225 Ac-DOTATATE, therefore, presents a novel strategy for metastatic NETs with high skeletal disease burden.