In patients with midgut neuroendocrine tumors that progressed during octreotide analogue therapy, the addition of 177 Lu-Dotatate to octreotide resulted in an 18% response rate and a significantly higher rate of progression-free survival at 20 months than high-dose octreotide alone. Neuroendocrine tumors of the midgut (which is defined as the jejunoileum and the proximal colon) commonly metastasize to the mesentery, peritoneum, and liver and are frequently associated with the carcinoid syndrome. 1 , 2 Neuroendocrine tumors of the midgut represent the most common type of malignant gastrointestinal neuroendocrine tumors and are associated with 5-year survival rates of less than 50% among persons with metastatic disease. 3 , 4 First-line systemic therapy usually consists of a somatostatin analogue for control of both hormonal secretion and tumor growth. 5 – 7 With the exception of everolimus for the treatment of nonfunctional neuroendocrine tumors, 8 no standard second-line systemic treatment . . .