Not all radiopharmaceuticals are the same for the treatment of neuroendocrine tumors (NETs), and therapeutic considerations should extend beyond a one-size-fits-all dosing regimen across tumor types and patients. At the 2026 Society of Nuclear Medicine & Molecular Imaging (SNMMI) Annual Meeting, studies assessing the role and real-world use of precision radiopharmaceuticals in NETs, along with the importance of patient perspectives on PRRT, were presented.

Following these presentations, featured expert Aman Chauhan, MD, was interviewed by Conference Reporter Editor-in-Chief Tom Iarocci, MD. Clinical perspectives from Dr Chauhan on these findings are presented here.

Not all questions can be answered by clinical trials, especially those related to rare cancers such as NETs, because of logistics, patient availability, and the resources that are required for management. So, many questions are answered through registries and real-world databases. However, one of the flaws of real-world databases is the quality of the data. Formalized registries such as the RadioPharmaceutical Therapy Registry (RaPTR), among others, help circumvent some of those quality issues.

RaPTR is an SNMMI-endorsed collaborative multicenter database that acquires clinical and radiographic information. Some of the goals of the RaPTR initiative include to find answers to research questions, generate supplemental data that will help devise guideline recommendations, and address current payer utilization–related challenges. Another key aim is to generate clean data sets, which can then help artificial intelligence “learn” theranostics, because artificial intelligence is only as good as the data set it has been trained on.

It is very early in terms of data collection, so we have not yet seen a lot of data coming out from the RaPTR database. There was an abstract presented at the recent 2026 SNMMI Annual Meeting by Bonnie Clarke, BS, that looked at the real-world use of PRRT and prostate-specific membrane antigen (PSMA), and the authors found a lot of discontinuation associated with PSMA-treated patients (abstract 262023). In fact, almost 50% of patients treated with ¹⁷⁷Lu-PSMA-617 did not complete a fifth cycle, and only 39% of patients finished all 6 cycles. It was also reported that patients treated with ¹⁷⁷Lu-dotatate had a relatively higher completion rate, with approximately 70% of patients who were treated with ¹⁷⁷Lu-dotatate completing all 4 planned cycles.

These are the real-world parameters. Why is this happening? What are the issues? We will have to figure that out down the road, but at least we can see that all theranostic drugs are not the same, and we are also seeing differences in their utilization.

Also at the 2026 SNNMI Annual Meeting, Elisabetta Perrone, MD, presented an interesting series of 20 patients with grade 3 neuroendocrine neoplasms who were treated with a novel alpha emitter that is an SSTR antagonist (abstract 261577). The authors reported manageable acute and midterm safety profiles and encouraging antitumor activity, but longer follow-up data are not yet available. While these are encouraging data, I would like to see this agent formally examined in a prospective protocol-based study.

With respect to precision medicine, patients are often very receptive to theranostics once it is explained well because the concept is very intuitive. We explain that we first image the target, and, if the cancer “lights up,” we use a similar molecule to deliver the treatment directly to those cancer cells. The idea is simple: first we see it, then we treat it. In my opinion, patients also generally find theranostics to be very appealing because it makes precision oncology visible. They can literally see their target on the positron emission tomography scan, which helps them understand why the treatment might work. For many patients, PRRT or radioligand therapy feels less like traditional chemotherapy and more like a targeted, biologically selected treatment.

At the same time, many patients do have concerns, especially about the word “radioactive,” the need to take radiation precautions around family members, logistics, travel to a specialized center, insurance approval, and uncertainties regarding long-term toxicity. Thus, patient education is critical. Once patients understand that the radiation is targeted, monitored, safe, and generally well tolerated, many are reassured.

Importantly, for patients with NETs, PRRT has been shown to improve not only progression-free survival (PFS) but also quality-of-life signals. I think that this is a key differentiator. We have many effective systemic therapies, such as targeted TKIs and chemotherapies, that have shown improvement in PFS. However, showing improvement in PFS and quality of life is a key differentiator, as shown in the NETTER-1 trial.