Real-world 177Lu-PRRT experience in a lower-middle-income country (LMIC): Treatment delivery, tumor response, safety, and rechallenge patterns.

Abstract

e16325 Background: 177Lu-peptide receptor radionuclide therapy (PRRT) is an established systemic option for metastatic neuroendocrine tumors (NETs). However, real-world evidence from LMIC settings remains limited. Affordability and infrastructure heavily affect access. We share our institutional outcomes, treatment delivery data, safety, and rechallenge utilisation. Methods: We analysed medical records of NET patients treated with 177Lu-PRRT at Sushrut Hospital, Mumbai, India. We summarized demographics, primary site, metastatic spread, PRRT cycles delivered, cumulative administered activity, treatment duration, toxicities, rechallenge use, and response at completion of 4 cycles were summarized descriptively Results: Twenty-six patients received 177Lu-PRRT. Median age was 47 years (range 18 to 70) and 65% were male (17/26). Primary sites were most commonly the pancreas (34.6%, 9/26) and the liver (23%, 6/26). Liver metastases were present in 69.2% (18/26), nodal disease in 57.7% (15/26), and bone metastases in 42.3% (11/26). Among 24 patients who received ≥2 cycles, the mean cycles delivered were 4.3 (median 4; range 2 to 7), with a mean cumulative activity of 596.8 mCi (median 592; range 282 to 1250). At completion of 4 cycles, best response was PR in 9, SD in 12, PD in 5, and CR in 0. This resulted in an ORR of 21.7% and a disease control rate of 69.6%. PRRT rechallenge was administered in 19% (5/26). In our center, a full 4-cycle PRRT course costs about USD 6,000, compared with the reported US Lutathera wholesale acquisition cost (WAC) of USD 55,896 per dose (USD 223,584 for 4 doses; drug cost only). Conclusions: In this real-world LMIC cohort, 177Lu-PRRT was deliverable in routine practice, achieving meaningful disease control (70%) without any Grade III/IV toxicities. Rechallenge was used in about 1 in 5 patients, showing that repeat treatment outside trials is feasible. The substantial affordability relative to the US highlights the potential for scalable PRRT access in resource-limited settings.