Carcinoid of small intestine
ICD-10 D37.2 · ICD-11 2B80.21

Treatment of Somatostatin Receptor-Positive Advanced Unresectable Small Intestine NET (Grade 1/2) Without Carcinoid Syndrome

This protocol covers the management of advanced, unresectable small intestine neuroendocrine tumours (SI-NET) that are grade 1 or grade 2, confirmed somatostatin receptor-positive, and present without carcinoid syndrome.

Clinical scenario

Advanced unresectable SI-NET — grade 1 or grade 2 — with confirmed somatostatin receptor positivity and no carcinoid syndrome. Receptor status is central to eligibility for the treatment approach in this setting.

Treatment approach (partial)

The regimen involves peptide receptor radionuclide therapy (PRRT) used in combination with a somatostatin analogue. Full sequencing, cycle structure, and dosing details are available in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jne.13423

In the presence of advanced unresectable Si-NET G1 or G2 long-acting SSA (either lanreotide or octreotide) is the preferred first-line treatment (RECOMMENDATION A-1b).

The recommended second-line treatment in the presence of SST-positive Si-NET is PRRT (RECOMMENDATION A-1b), followed by everolimus (RECOMMENDATION A-1b).

In the NETTER-1 phase 3 study patients with advanced progressive Si-NET were randomised to four cycles of 177Lutetium (177Lu)-DOTATATE (every 8 weeks) combined with Octreotide LAR 30 mg every 28 days or high dose Octreotide LAR 60 mg every 4 weeks.

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