High degree of implementation of intended management changes after ^sup 68^Ga-DOTATATE PET/CT imaging in patients with neuroendocrine tumors

Objectives: Somatostatin receptor (SSR) targeted PET/CT with 68Ga-DOTATATE (NETSPOT) is now FDA approved and reimbursed by the Centers for Medicare and Medicaid Services (CMS) for patients with neuroendocrine tumors. In a prospective study we have previously reported intended management changes as a consequence of 68Ga-DOTATATE PET/CT imaging in 60% of patients. In the current study we determined whether intended management changes were in fact implemented. Methods: Eighty-six patients with suspected SSR expressing NETs were prospectively enrolled to undergo 68Ga-DOTATATE PET/CT for initial or subsequent management decisions (NCT02174679). Referring physicians were asked to complete one questionnaire prior to the scan (Q1) to indicate the treatment plan without PET/CT information; one immediately after review of the imaging report to denote intended management changes (Q2); and one 6 months later (Q3) to verify whether intended changes were in fact implemented. Results: 68Ga-DOTATATE PET/CT resulted in intended management changes in 37/86 (43%) patients. These management changes were implemented in 31 of the 37 patients (84%). In detail, prior to acquisition of the PET/CT study 11 patients were scheduled to undergo surgery. Eight of these 11 patients (72%) were switched to conservative treatment as a consequence of 68Ga-DOTATATE. Conversely, 8/27 patients (30%) were moved from a non-surgical to a surgical management strategy. Eleven of 23 patients were switched from treatment to simple surveillance (48%). 66% of the patients who were initially scheduled for chemotherapy finally had other therapeutic options (4/6). In 6/37 patients (16 %) the intended management change was not implemented. Reasons for lack of implementation included: patient decision (n=1), second opinion (n=1), tumor board decision (n=1), unkown (n=3). Conclusion: This prospective referring physician survey i) confirms a substantial impact of 68Ga-DOTATATE PET/CT on patient management and ii) demonstrates a high degree of implementation of intended management changes after 68Ga-DOTATATE PET/CT imaging in patients with neuroendocrine tumors.