Survey of Early Adopters of Peptide Receptor Radionuclide Therapy with Lu-177-dotatate in the USA

Introduction: On January 26, 2019, the U.S. FDA approved Peptide Receptor Radionuclide Therapy (PRRT) with Lu-177-dotatate for the treatment of gastroenteropancreatic neuroendocrine tumors (NETs). This survey was conducted on previously validated sample to determine the early adoption of PRRT in the U.S.A. as of April-May, 2019. Method: Previously validated database of 365 U.S. practicing nuclear medicine specialists was surveyed. Two questions were asked: 1) Are you currently treating patients with Lu-177-dotatate? 2) If you are not, are you planning to start in the next 6 months? Those responding negative to the latter question were followed with a more detailed inquiry into reasons and long-term plans.

Results: There were 99 respondents (27%), representing 80 separate practice sites. These site(s) were located in the following states: AL (1), AZ (1), CA (6), CO (1), CT (1), DC (1), FL (5), GA (1), Hawaii (1), IA (2), IL (2), IN (2), KY (1), LA (1), MA (5), MD (4), MI (2), MN (1), MO (1), NC (3), NJ (1), NM (2), NY (5), OH (3), OR (1), PA (5), PR (3), RI (1), SC (1), SD (1), TN (3), TX (9), UT (1), WA (1), and WV (1). Academic facilities with residency programs constituted 65/80 respondent sites (81%). Overall, 46 (58%) of sites were using PRRT. Of the 34 who were not, 15 were planning to start in the next 6 months. However, 19 (24% of all) sites, predominantly (11/19 [58%]) community practices made no plans to introduce PRRT into their practice in the next 6 months. Conclusion: The academic facilities are early adopters of PRRT while community sites are more likely to delay it significantly. The economics and cumbersome logistics of PRRT, as well as the rarity of NETs, are the likely considerations in this decision making. Because community practices are the most accessible to patients in the USA, a wider survey of patient access to PRRT in the USA is warranted.