Abstract
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.