{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:32:01Z","timestamp":1782912721893,"version":"3.54.5"},"reference-count":11,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The present report describes the history of a 58-year-old woman with a rapidly progressing neuroendocrine pancreatic tumor (initially G2) presenting with extensive liver, bone, and lymph node metastases. Previous treatments included chemotherapy, hemithyroidectomy for right lobe metastasis, Peptide Receptor Radionuclide Therapy (PRRT) with [177Lu]Lu-DOTATATE, Lanreotide, Everolimus, and liver embolization. Due to severe disease progression, after a liver biopsy revealing tumor grade G3, PRRT with the somatostatin receptor antagonist LM3 was initiated. [68Ga]GaDOTA-LM3 PET\/CT showed intense tracer uptake in the liver, pancreatic tumor, lymph nodes, and bone metastases. Three TANDEM-PRRT cycles using [177Lu]LuDOTA-LM3 and [225Ac]AcDOTA-LM3, administered concurrently, resulted in significant improvement, notably in liver metastases, hepatomegaly reduction, the complete regression of bone and lymph node metastases, and primary tumor improvement. Partial remission was confirmed by positron emission tomography\/computed tomography, chest\u2013abdomen\u2013pelvis contrast-enhanced computed tomography, and magnetic resonance of the abdomen, with marked clinical improvement in pain, energy levels, and quality of life, enabling full resumption of physical activity.<\/jats:p>","DOI":"10.3390\/diagnostics14090907","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T08:42:57Z","timestamp":1714639377000},"page":"907","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Impressive Response to TANDEM Peptide Receptor Radionuclide Therapy with 177Lu\/225AcDOTA-LM3 Somatostatin Receptor Antagonist in a Patient with Therapy-Refractory, Rapidly Progressive Neuroendocrine Neoplasm of the Pancreas"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8404-8206","authenticated-orcid":false,"given":"Elisabetta","family":"Perrone","sequence":"first","affiliation":[{"name":"CURANOSTICUM Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, 65191 Wiesbaden, Germany"},{"name":"Institute of Nuclear Medicine, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kriti","family":"Ghai","sequence":"additional","affiliation":[{"name":"CURANOSTICUM Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, 65191 Wiesbaden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9750-236X","authenticated-orcid":false,"given":"Aleksandr","family":"Eismant","sequence":"additional","affiliation":[{"name":"CURANOSTICUM Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, 65191 Wiesbaden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1656-3516","authenticated-orcid":false,"given":"Mikkel","family":"Andreassen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Copenhagen University Hospital\u2014Rigshospitalet, 2100 Copenhagen, Denmark"},{"name":"ENETS Center of Excellence, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seppo W.","family":"Langer","sequence":"additional","affiliation":[{"name":"ENETS Center of Excellence, 2100 Copenhagen, Denmark"},{"name":"Department of Oncology, Copenhagen University Hospital\u2014Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Knigge","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Copenhagen University Hospital\u2014Rigshospitalet, 2100 Copenhagen, Denmark"},{"name":"ENETS Center of Excellence, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2706-5547","authenticated-orcid":false,"given":"Andreas","family":"Kjaer","sequence":"additional","affiliation":[{"name":"ENETS Center of Excellence, 2100 Copenhagen, Denmark"},{"name":"Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging, Copenhagen University Hospital\u2014Rigshospitalet, 2100 Copenhagen, Denmark"},{"name":"Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1723-0075","authenticated-orcid":false,"given":"Richard P.","family":"Baum","sequence":"additional","affiliation":[{"name":"CURANOSTICUM Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, 65191 Wiesbaden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S1470-2045(07)70410-2","article-title":"Gastroenteropancreatic neuroendocrine tumours","volume":"9","author":"Modlin","year":"2008","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1001\/jamaoncol.2017.0589","article-title":"Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States","volume":"3","author":"Dasari","year":"2017","journal-title":"JAMA Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1056\/NEJMoa1607427","article-title":"Phase 3 trial of 177Lu-Dotatate for midgut neuroendocrine tumors","volume":"376","author":"Strosberg","year":"2017","journal-title":"N. 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Radiopharm."},{"key":"ref_7","first-page":"1232","article-title":"Ac-225-DOTATOC\u2014An empiric dose finding for alpha particle emitter based radionuclide therapy of neuroendocrine tumors","volume":"56","author":"Kratochwil","year":"2015","journal-title":"J. Nucl. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.2967\/jnumed.120.258889","article-title":"First-in-humans study of the SSTR antagonist 177Lu-DOTA-LM3 for Peptide Receptor Radionuclide Therapy in patients with metastatic neuroendocrine neoplasms: Dosimetry, safety, and efficacy","volume":"62","author":"Baum","year":"2021","journal-title":"J. Nucl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"260","DOI":"10.2967\/jnumed.115.167007","article-title":"Comparison of the therapeutic response to treatment with a 177Lu-labeled somatostatin receptor agonist and antagonist in preclinical models","volume":"57","author":"Dalm","year":"2016","journal-title":"J. Nucl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.2967\/jnumed.117.191684","article-title":"Biodistribution, pharmacokinetics, and dosimetry of 177Lu-, 90Y-, and 111In-labeled somatostatin receptor antagonist OPS201 in comparison to the agonist 177Lu-DOTATATE: The mass effect","volume":"58","author":"Nicolas","year":"2017","journal-title":"J. Nucl. 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