Beyond Traditional Methods: Enhancing Durability in NETs Care with Combined Therapy

In an interview with Targeted Oncology at the 2025 North American Neuroendocrine Tumor Society (NANETS) Symposium, Michael Soulen, MD, discussed the combined therapy approach for patients with liver-dominant neuroendocrine tumors (NETs). Soulen noted that while traditional liver-directed therapies like bland embolization, chemoembolization, and radioembolization have been used effectively for over 50 years, there is a continuous push to enhance treatment durability.

The outlined treatment protocol involves a combination of systemic chemotherapy and peptide receptor radionuclide therapy (PRRT) using Lutetium-177 dotatate. This is a novel combination therapy, not yet a standard-of-care.

The treatment schedule is highly defined: patients receive an initial cycle of systemic chemotherapy, typically temozolomide and Cap/Tem, to ensure they can tolerate it. During the first month, they also undergo a simulation for PRRT, including a DOTA-octreotate or lanreotide scan and a routine SPEC scan, to confirm the safety and feasibility of the renormalization procedure.

The combined therapy begins in the second month. The PRRT procedure—dropping Lutetium-177 dotatate—is precisely scheduled for day 7 of the 14 days of chemotherapy. The goal is to maximize the tumoricidal effects by potentially utilizing the chemotherapy's sensitizing effects, though the protocol is subject to modification based on a patient’s tolerability and the need for bone marrow recovery. The treatment is then continued for 4 total cycles, delivered in a monthly or near-monthly rhythm.

The primary objective is to make the existing, effective therapies more potent and long-lasting.