Managing hematological toxicity in [¹⁷⁷Lu]Lu-DOTATATE for NET patients: a national survey from the French group of endocrine tumors (GTE) on the clinical need for harmonized monitoring strategies.

Abstract

Peptide receptor radionuclide therapy (PRRT) with [¹⁷⁷Lu]Lu-DOTATATE is a standard treatment for metastatic neuroendocrine tumors (NET), but management of hematological toxicity beyond the thresholds defined in the Summary of Product Characteristics (SmPC) relies heavily on individualized clinical judgment. To characterize real-world practices, we conducted a national anonymous survey among French nuclear medicine physicians and medical oncologists involved in PRRT, under the auspices of the SFMN, GTE, and ENDOCAN-RENATEN network. Forty expert physicians completed the 45-item LutaViRe questionnaire. Results show that clinicians frequently apply higher platelet thresholds than the SmPC minimum, adjust first-cycle activity, and rely on individualized, often multidisciplinary strategies when facing acute or persistent thrombocytopenia. Nutritional deficiency screening and structured long-term hematological monitoring, including for therapy-related myeloid neoplasms, remain insufficiently implemented. These findings reveal substantial heterogeneity in the real-world hematological management of [¹⁷⁷Lu]Lu-DOTATATE and support the development of harmonized, individualized monitoring guidelines integrating patient risk profiles and systematic pharmacovigilance reporting.