177Lu-labelled peptide receptor radionuclide therapy in patients with neuroendocrine tumors: a systematic review and meta-analysis

Objective This systematic review and meta-analysis evaluated the efficacy and safety of 177 Lu-labelled peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors (NETs). Methods This systematic review and meta-analysis conducted a search of the PubMed/MEDLINE, Embase, and Web of Science databases. Included studies assessed treatment outcomes using Response Evaluation Criteria in Solid Tumors (RECIST) or World Health Organization (WHO) criteria. A random-effects model was used to calculate pooled proportions. Results A total of 14 studies with 1844 patients were included. The pooled disease control rate (DCR) was 87.6% (95% Confidence Interval (CI), 82.5%-92%), and the objective response rate (ORR) was 32.2% (95% CI, 25.4%-39.3%). Median progression-free survival (PFS) was 30.87 months (95% CI, 22.71–39.04), and median overall survival (OS) was 51.85 months (95% CI, 39.99–63.71). Subgroup analysis revealed a significantly higher DCR in grade 1–2 NETs 97.7% (95% CI, 91.4%-100%) compared to grade 3 NETs 90.8% (95% CI, 85.1%-94.4%), and a higher ORR in grade 1–2 tumors 45.4% (95% CI, 35.3%-55.6%) compared to grade 3 tumors 27.1% (95% CI, 21.2%-33.4%). PFS was longer in pancreatic NETs 93.9 months (95% CI, 39.45–148.35) than in gastrointestinal NETs 66.32 months (95% CI, 41.78–90.87). The overall incidence of adverse events was 4.1%, with grade ≥3 toxicities in 4.3%. 177 Lu-PRRT demonstrates high efficacy and a favorable safety profile in treating NETs. Conclusion 177 Lu-DOTA-Tyr3-octreotate ( 177 Lu-DOTATATE) demonstrates high efficacy and a favorable safety profile in treating NETs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251047030.