Objectives: The two main Theranostic therapies are 177Lu-DOTATATE which is FDA-approved for the treatment of neuroendocrine tumors (NETs) and 177Lu-PSMA which is not yet FDA approved. These therapies have been standard of care for many parts of the world leaving the United States behind. The objective of this study is to compare the differences of these therapies between the US and other parts of the world.

Methods: Protocols, patient selection and pricing were reviewed through published literature for treatment with 177Lu-DOTATATE in the United States and compared to Australia then to Germany.

Results: In comparing literature, we found the FDA approved treatment for patients with NETs affecting the pancreas or gastrointestinal tract whereas in Australia all NETs can be treated. Also, the US has a standard protocol for all treatments while Australia tailors treatment to each patient based on tumor aggressiveness and other variables. Price also varies significantly costing $50,000 USD per dose in the US vs $5,500 USD in Australia.

Comparing the literature for 177Lu-PSMA is not as straightforward since it is still undergoing clinical trials in the US. Nevertheless, in Germany the total cost of the treatment is $16,000 USD which includes admission into the hospital for 5 days and all labs/imaging.

Conclusion: The United States is behind the rest of the world in Theranostics. Therapies in the US lack personalization and are offered at a significantly higher cost. The counterparts across the world can tailor these therapies to their patients at a fraction of the cost.

Susan Bjork would like to thank their faculty sponsor Crystal Botkin for their support of this project.