Dr Dasari on Emerging PRRT Options and New Therapeutic Targets in NETs

Arvind Dasari, MD, MS, outlines the most important therapeutic developments in neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs) from the past year to year and a half. In this interview from the 2026 North American Neuroendocrine Tumor Society (NANETS) Symposium, he discusses the rapid growth of novel therapies, an expanding field of peptide receptor radionuclide therapy (PRRT) options, the first phase 3 trial of an alpha-emitting targeted radiopharmaceutical therapy to report positive results, and ongoing research with next-generation VEGF tyrosine kinase inhibitors.

Dasari, a professor in the Department of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center, describes neuroendocrine carcinoma as a malignancy that has long been difficult to treat and manage. Against that backdrop, he calls the pace of novel therapy development in this space very welcome, and he points to the substantial volume of research underway.

Clinical trial enrollment is the first theme Dasari emphasizes. Because so many novel therapies are being developed against novel targets, he encourages enrolling patients onto clinical trials whenever possible, in both the frontline and second-line settings, so they can gain access to these emerging agents.

The second key development involves PRRT. For a long time, Dasari explains, PRRT was synonymous with a single product, and that is no longer the case. Several additional PRRT approaches are now in development, expanding beyond the established lutetium Lu 177 dotatate (Lutathera) treatment. These include other beta-emitter approaches, including therapies based on lutetium-177.

Beyond beta emitters, Dasari highlights ACTION-1 as the first phase 3 trial of an alpha-emitting targeted radiopharmaceutical therapy to report positive results. Based on topline findings, the trial met its primary end point of progression-free survival (PFS). A more detailed report of the findings is still anticipated, and Dasari expects additional alpha-emitter trials to launch.

Dasari also addresses VEGF-targeted therapy across neuroendocrine tumors. Cabozantinib (Cabometyx) remains the only VEGF-targeted tyrosine kinase inhibitor with an FDA-approved indication covering previously treated, advanced, well-differentiated pancreatic and extra-pancreatic NETs. An ongoing phase 2/3 trial is evaluating zanzalintinib, a next-generation multikinase inhibitor targeting VEGFR2 and other receptors, in patients with previously treated, well-differentiated NETs, and Dasari encourages considering enrollment onto that trial where it is available.

Taken together, Dasari frames 3 areas as the key takeaways from recent progress in the field: novel therapies against novel targets in clinical trials, a growing range of beta- and alpha-emitter PRRT approaches, and continued development of VEGF tyrosine kinase inhibitors beyond cabozantinib.