How does avidity on DOTATATE PET impact your choice of whether to start somatostatin analogues in metastatic neuroendocrine tumors?

A negative DOTATATE scan is predictive for a lack of response to SSA therapy including Lutathera so I would not use octreotide or lanreotide for this patient and I would choose something else for treatment. (See for example Lee et al., PMID 32886441)