Somatostatin receptors are overexpressed in GEP-NETs and can be visualized in vivo by
During the last decades, conventional scintigraphy using 111In-DTPA-Octreotide (often named
somatostatin receptor scintigraphy or SRS) was considered as the gold standard nuclear
imaging technique in the evaluation of GEP-NETs. However, SRS may be suboptimal in this
clinical setting because of the low intrinsic resolution of the technique and its selectivity
for SST2 only. Its overall sensitivity is estimated to 60-70% (per lesion analysis), even
when using the most recent SPECT-CT cameras. MRI have also a higher sensitivity than CT and
SRS for the detection of liver metastases from GEP-NETs.
In recent years, positron emission tomography (PET) imaging, a high resolution and sensitive
technology, has gained an increasing role in oncology. It has also been evaluated in GEP-NETs
with somatostatin agonists (SSTa) radiolabelled with Gallium-68 [68Ga], a positron emitter
with very promising results. Its diagnostic sensitivity is clearly superior to SRS and many
European centers have already replaced SRS by [68Ga]-PET-SSTa.
Currently, three different [68Ga]-coupled peptides can be used in trials: DOTA-TOC, DOTA-TATE
and DOTA-NOC with excellent affinities for SST2 (IC50: 2.5; 0.2 and 1.9 nM, respectively).
Sensitivities of DOTA-TOC and DOTA-TATE PET/CT are quite similar.
[68Ga]-DOTANOC which also binds to SST5 was recently found to detect significantly more
lesions than the SST2-specific radiotracer [68Ga]-DOTATATE in patients with GEP-NETs but this
requires further evaluation.
It is therefore important to determine the interest of [68Ga]-DOTANOC combined with the
standard diagnosis strategy in GEP-NETs and evaluate medicoeconomic impact of adding
[68Ga]-DOTANOC in the work-up of patients.
The investigators hypothesis is that [68Ga]-DOTANOC will modify the management in at least
20% of patients in a more adapted way according to the 2012 ENETS guidelines in comparison to
the decision based on the standard imaging work up (multiphasic WB CT, liver MRI and SRS).
110 patients will be included prospectively in 5 different French experienced centers
(Marseille, Bordeaux, Toulouse, Paris, Clermond-Ferrand).
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AP-HM, Marseille, France
Not yet recruiting