Molecular Theranostics for treatment of Metastic Neuroendocrine Tumour

A 64-year-old gentleman presented with multiple liver lesions. Biopsy revealed a grade II metastatic neuroendocrine tumor Ga-68 DOTANOC PET/CT showed only secondaries in the liver with high somatostatin receptor positivity in all the lesions and no obvious primary. Patient was put on first line of management with octreotide long acting repeatable. But he was having progressive disease with increase in size of the liver lesions. Further patient was taken up for PRRT (peptide receptor radionuclide therapy) with Lutetium-177 DOTATATE. It is a specific radioactive molecule that delivers radiation only to this variety of tumours expressing this particular receptor with very limited side effects to the rest of the body as compared to conventional chemotherapy or radiotherapy. In this patient, post 1 cycle of therapy, there is no further increase in size of the lesion with no new lesions, thereby achieving stable disease. This type of management is available only in very few centers throughout the country and Dharan Hospital is the only center in Salem providing this line of treatment.