PET/CT with Ga-68 DOTATATE has been found to change treatment plans in a majority of patients receiving initial evaluation and subsequent staging of neuroendocrine tumors (NETs), according to the results of two referring physician surveys published Dec. 11 in the Journal of Nuclear Medicine . Amino-acid PET is gaining increasing traction for the evaluation of NETs—particularly agents that provide information about somatostatin receptor (SSTR) expression. Ga-68 DOTATATE is just such an agent. Ken Herrmann, MD, from Ahmanson Translational Imaging and the department of molecular and medical pharmacology at David Geffen School of Medicine at the University of California, Los Angeles, and colleagues conducted the survey, targeting the referring physicians treating 100 consecutive NET patients in order to evaluate any changes in patient management resulting from PET/CT with Ga-68 DOTATATE. “As metastases at the time of diagnosis are present in around 20 percent to 50 percent and tumors recur in 40 percent to 60 percent of patients, there is a clinical need for an imaging assay that allows for precise staging and restaging of the disease while at the same time serving as a predictive biomarker for treatment,” wrote Hermann et al. Survey response rate was 88 percent. PET/CT was indicated for 14 percent of patients in initial evaluation and for 86 percent of patients in follow-up staging. DOTATATE PET/CT led to an increased suspicion of metastatic disease in 21 patients (24 percent). Referring physicians’ suspicion of metastatic disease was either increased (10 percent) or diminished (14 percent). Patient management was changed in 53 out of 88 cases (60 percent). A total of 20 patients were spared chemotherapy and 7 percent went from “watch and wait” status to active treatment protocols, whereas 6 percent of patients’ cases were changed from a more invasive treatment strategy to careful observation. “In summary, Ga-68 DOTATATE PET/CT affects the intended management of 60 percent of patients with SSTR expressing neuroendocrine tumors,” the researchers concluded. “Future studies will need to determine prospectively whether these management changes are implemented and if treatment changes have an impact on patient outcome.” DOTATATE is currently not FDA approved, but researchers are pushing for its approval due to its already validated efficacy compared to similar SSTR agents, namely DOTANOC.

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