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Sunday 15 July 2018
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European approval of lutetium (177Lu) oxodotreotide for GEP-NET tumours

Advanced Accelerator Applications S.A has announced that the European Commission (EC) has approved the marketing authorisation of Lutathera® (lutetium (177Lu) oxodotreotide) for the treatment of unresectable or metastatic, progressive, well differentiated (G1 and G2), somatostatin receptor positive gastroenteropancreatic neuroendocrine tumours (GEP-NETs) in adults.


This approval allows for the marketing of Lutathera® (lutetium (177Lu) oxodotreotide) in all 28 European Union member states, as well as Iceland, Norway and Liechtenstein.


The approval is based on results of a randomised pivotal Phase 3 study, NETTER-1 that compared treatment using Lutathera® (lutetium (177Lu) oxodotreotide) with a double dose of octreotide LAR in patients with inoperable midgut NETs progressive under standard Octreotide LAR treatment and overexpressing somatostatin receptors, as well as efficacy and safety data from the Erasmus Phase 1/2 trial conducted in more than 1200 patients with a wide range of NET indications including foregut (including bronchial and pancreatic), midgut and hindgut.


The European Medicines Agency requested an update of NETTER-1 efficacy results with a cut-off date of June 30, 2016. The findings of this update were consistent with previously published results.1


The NETTER-1 study met its primary endpoint, showing a reduction of risk of progression or death of 79% using lutetium (177Lu) oxodotreotide (Lutathera®) compared to octreotide LAR 60 mg. Although the final Overall Survival (OS) analysis (secondary endpoint) is planned for after the first of either 158 cumulative deaths, or five years after the last patient is randomised; the current update (after 71 cumulative deaths), also confirmed the favourable trend of 28 deaths in the lutetium (177Lu) oxodotreotide (Lutathera®) arm versus 43 in the octreotide LAR 60 mg arm.


The median OS in the octreotide LAR arm was 27.4 months, but was still not reached in the lutetium (177Lu) oxodotreotide (Lutathera®) arm after 42 months, with a Hazard Ratio (HR) of 0.536, meaning a reduction of risk of death of 46% using lutetium (177Lu) oxodotreotide (Lutathera®) compared to octreotide LAR 60 mg.2


Martyn Caplin, Professor of gastroenterology and GI neuroendocrinology at the Royal Free London and University College London and Vice Chair (former Chairman) of the European Neuroendocrine Tumour Society, stated, “There are very few effective treatment options for patients with inoperable, advanced GEP-NETs who are progressive on somatostatin analogues. Having this therapy approved and available will offer physicians a further option to help manage their patients’ disease.”


Gastroenteropancreatic neuroendocrine tumours, also known as GEP-NETs, are a group of tumours originating in the neuroendocrine cells of numerous organs. Lutathera® (lutetium (177Lu) oxodotreotide) has received orphan drug designation from the European Medicines Agency. The estimated incidence of gastrointestinal NETs in the UK is approximately 2.65 per 100,000 per year, while the estimated incidence of pancreatic NETs in the UK is less than 0.2 per 100,000 per year.3 However, since NETs are often slow-growing and associated with prolonged survival, the prevalence of NETs is relatively high.4


Catherine Bouvier, Chief Executive Officer of NET Patient Foundation, a NET patient advocacy group/charity in the UK, noted, “The NET patient community welcomes the approval of Lutathera®. Due to the orphan nature of NETs and difficulty in obtaining proper diagnosis, many patients are not diagnosed until their disease has become quite advanced. Disease progression significantly impacts quality of life and limits the time with family and friends.”



  1. Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, Mittra E, Kunz PL, Kulke MH, Jacene H, et al. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med 2017; 376: 125-35. DOI: 10.1056/NEJMoa1607427
  2. Advanced Accelerator Applications. Lutathera® (lutetium (177Lu) oxodotreotide) Summary of Product Characteristics (SmPC). 2017.
  3. Ramage J, Ahmed A, Ardill J, Bax N, Breen JD, Caplin ME, Corrie P, Davar J, Davies AH, Lewington V, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs). Gut 2012;61: 6─32.
  4. Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008;26:306372.

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