Systemic radionuclide treatments in gastro-entero-pancreatic neuroendocrine tumours

PURPOSE OF REVIEW: Systemic radionuclide therapy has become a cornerstone in the management of advanced gastro-entero-pancreatic neuroendocrine tumours (GEP-NETs). Following the establishment of β-emitting peptide receptor radionuclide therapy (PRRT) as an effective treatment for somatostatin receptor positive NETs, recent clinical and translational advances have substantially expanded its therapeutic scope. Several pivotal randomised trials published within the past 18 months justify a reassessment of radionuclide treatment strategies in GEP-NETs. RECENT FINDINGS: Recently published results of randomised phase III trials support a broader and more strategic use of PRRT, such as in selected high-grade well differentiated NETs. Direct comparisons of PRRT and targeted therapies redefine therapeutic sequencing. Radiosensitising combinations and next-generation theranostic platforms, including alpha-emitting radionuclides, are entering late-phase development. SUMMARY: Radionuclide therapy in GEP-NETs is transitioning from a late-line option toward a flexible, biology-driven treatment strategy with important implications for clinical practice.