A significant step forward in the treatment of neuroendocrine cancers in Australia came into effect on 1 November 2025, when the Medicare Benefits Schedule (MBS) will list a new item for peptide receptor radionuclide therapy (PRRT) utilising the agent lutetium-177-DOTATATE (often abbreviated Lu-DOTATATE or Lu-DOTA).
This change marks a major milestone in making advanced radionuclide therapies more accessible for eligible NET patients in Australia.
NeuroEndocrine Cancer Australia (NECA), is dedicated to assisting individuals diagnosed with NETs and their loved ones. NECA offers a wealth of resources, educational programs, and advocacy efforts aimed at deepening the understanding of NETs, improving patient care, and encouraging research advancements. Patients can engage with NECA’s comprehensive support and information by calling the NET nurse line.
What Is PRRT (Lu-DOTA)?
Peptide Receptor Radionuclide Therapy (PRRT) is a targeted molecular therapy designed to deliver radiation directly to tumour cells. In the case of Lu-DOTA:
- The radioactive isotope lutetium-177 (Lu-DOTA) is attached to a peptide that binds to somatostatin receptors, which are commonly over-expressed on many neuroendocrine tumour cells.
- When the peptide binds to the receptor, the radioisotope is internalised, delivering radiation locally to the tumour while minimising exposure to surrounding healthy tissue.
This therapy differs from conventional external beam radiotherapy by the way it seeks out tumour cells via receptor binding rather than treating a broad region. For suitable patients, PRRT has shown tumour shrinkage, symptom relief in functioning tumours, and prolongation of progression-free survival.
How Lu-DOTA targets somatostatin receptors in NETs
NETs often express somatostatin receptors (SSTRs) on their cell surface. Lu-DOTA is designed to exploit this by linking a somatostatin analogue (which binds to SSTRs) to the radioisotope lutetium-177. Once injected, the compound circulates, binds to receptor-positive tumour cells, and delivers internalised radiation that damages tumour DNA, inhibits cell division, and can lead to tumour cell death or growth arrest.
Patients are assessed before treatment via imaging studies such as Ga-68-DOTATATE PET/CT to confirm sufficient somatostatin receptor expression and suitability for PRRT. This precision-targeting mechanism is what makes PRRT such a compelling option in appropriately selected NET patients.
The significance of the new Medicare item
From 1 November 2025, the MBS will include a dedicated item number for Lu-DOTA PRRT. For patients in Australia, this update means:
- A reduction in out-of-pocket costs for eligible PRRT treatments in both public and private settings.
- Improved equity of access, ensuring that more NET patients who meet the criteria can receive this therapy without prohibitive financial barriers.
- Formal recognition of PRRT as an integral part of NET management in Australian clinical practice guidelines and funding frameworks.
For NET patients and their families, this listing offers hope for improved access to one of the most effective systemic treatments currently available for somatostatin-receptor positive disease.
Improving accessibility for NET patients
Historically, access to PRRT in Australia was limited by factors including cost, geographic availability, and funding models. With the new Medicare listing:
- Patients in rural and regional areas may find it easier to access treatment as centres expand offerings under the MBS framework.
- Public hospitals and private clinics may be more incentivised to set up PRRT programs, increasing capacity and reducing wait times.
- Patients with private health insurance and those treated in public centres can benefit from reduced financial burden, improving overall care equity.
This listing demonstrates a shift in policy towards recognising the importance of advanced treatments in improving NET outcomes and ensuring that geography or insurance status does not unduly hinder access.
Who may be eligible
Eligibility for PRRT generally depends on disease characteristics and patient health status. Typical criteria include:
- Confirmed diagnosis of a neuroendocrine tumour with documented somatostatin receptor positivity on PET/CT imaging.
- Adequate renal and bone marrow function to tolerate radionuclide therapy and mitigate risk of toxicity.
- Disease progression on or intolerance to first-line therapies such as somatostatin analogues (SSAs).
- Multidisciplinary assessment by a NET specialist team, including nuclear medicine, medical oncology, endocrinology, and surgery.
Referral to a specialist centre is important to confirm suitability, manage pre-treatment preparations, and coordinate multidisciplinary care. The MBS listing reinforces the need for accredited nuclear medicine facilities and specialist oversight to ensure safe and effective delivery.
Clinical benefits of PRRT in NET care
Evidence for PRRT is strong in the setting of somatostatin-receptor positive NETs. Clinical trials and real-world studies report:
- Improved progression-free survival (PFS) in patients who receive PRRT compared with those who continue on SSA therapy alone.
- Reduction in tumour size (partial responses) and disease stabilisation in a majority of selected patients.
- Symptom relief in functioning tumours, with reductions in hormone-mediated symptoms such as flushing, diarrhoea, and wheezing.
- Improved quality of life, as patients experience fewer symptomatic episodes, reduced hospitalisations, and better everyday functioning.
By formalising Medicare coverage, the Australian healthcare system will allow more patients to benefit from these outcomes, aligning access with best practice evidence for NET care.
Supporting safe and effective use
With the inclusion of PRRT into the MBS comes the requirement that treatment is provided in accredited nuclear medicine centres that meet safety and quality standards. Key aspects include:
- Pre-treatment assessment of patient overall health, renal and marrow function, and imaging confirmation of somatostatin receptor expression.
- Administration of therapy under strict radiation-safety protocols, with monitoring for side-effects such as nausea, mild bone marrow suppression, and kidney function changes.
- Structured follow-up involving imaging and biochemical markers to monitor response, manage late side-effects, and guide further therapy.
Accreditation and multidisciplinary oversight help ensure that PRRT is delivered safely, effectively, and consistently across treatment centres in Australia.
Looking ahead
The Medicare listing of Lu-DOTA PRRT is a significant stride towards equity in NET treatment access. It sends a clear message that advanced therapies are not only for select patients but should be available to all eligible Australians regardless of location or insurance status.
Continued research and refinement of PRRT protocols remain vital. Areas of ongoing development include:
- Earlier use of PRRT in the treatment pathway, potentially before extensive metastasis occurs.
- Combination therapies that integrate PRRT with systemic drugs or immunotherapy to improve long-term outcomes.
- Longitudinal studies evaluating the impact of PRRT on survival, organ function, and quality of life in the Australian population.
- Enhanced data collection and registry work to monitor results, inform best-practice models, and identify patients most likely to benefit.
The 1 November 2025 Medicare item represents not just a funding milestone but a broader shift in how NET treatment is delivered in Australia. By making PRRT more accessible, we move closer to a future where more patients receive timely, high-quality, evidence-based care, and where the burden of NETs is reduced through better outcomes and improved quality of life.
Further information and support for people diagnosed with NETs is available by calling the NECAÂ NET nurse line.
Sources
- Australian Government Department of Health.
Medicare Benefits Schedule (MBS) listing for Lu-DOTA PRRT.
https://www.health.gov.au/resources/medicare-benefits-schedule - European Association of Nuclear Medicine (EANM).
EANM procedure guideline for peptide receptor radionuclide therapy with Lu-177-DOTATATE.
https://link.springer.com/article/10.1007/s00259-018-4207-0 - Strosberg J, El-Haddad G, Wolin E, et al.
Phase 3 trial of Lu-177-DOTATATE for mid-gut neuroendocrine tumours.
https://www.nejm.org/doi/full/10.1056/NEJMoa1607427 - NeuroEndocrine Cancer Australia.
PRRT in neuroendocrine tumours: current status and future directions.
https://neuroendocrine.org.au/prrt/ - Kong G, Fisher D, Hofman MS.
Long-term survival and effect of PRRT in pancreatic and other NETs.
https://jnm.snmjournals.org/content/61/9/1328 - Chan DL, Hofman MS, Kong G.
Real-world experience with Lu-177-DOTATATE in Australia.
https://www.sciencedirect.com/science/article/pii/S1058166922006630 - National Comprehensive Cancer Network (NCCN).
Neuroendocrine and adrenal tumours guidelines.
https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf - O’Brien ME, Kwon D, et al.
Cost-effectiveness of PRRT in neuroendocrine tumours.
https://www.frontiersin.org/articles/10.3389/fonc.2023.1171567/full - Society of Nuclear Medicine and Molecular Imaging (SNMMI).
Accreditation and practice standards for PRRT in Australia.
https://www.snmmi.org/PRRT - Australian Government Cancer Australia.
Improving access to care for rare cancers: NETs in Australia.
https://www.canceraustralia.gov.au/rare-cancers
