Please note that only Ontario residents will be eligible for participation in this trial.

        Inclusion Criteria:

          1. Biopsy-proven neuroendocrine tumor

          2. ECOG performance status ≤ 2

          3. Ki-67 index ≤ 30%

          4. Evidence of progressive disease demonstrated by imaging within six months prior to
             study enrollment as defined by RECIST v1.1.

               -  Tumor board discussion of cases to confirm suitability for participation in the
                  clinical trial is required. Review should include but not limited to imaging
                  review, pathology (including Ki 67) and treatment options.

               -  Patients with objective evidence (imaging, or biochemical) that is insufficient
                  to be classified by RECIST 1.1 criteria can be eligible if after provincial
                  multidisciplinary tumor board discussion a consensus for progression eligibility
                  is reached.

               -  The tumor board would consider exemptions if the magnitude of change is adequate
                  by other definitions (e.g. using structural and contrast patterns and biochemical
                  changes).

               -  Where clinically indicated, formal consultation on pathology, diagnostic imaging
                  to facilitate criteria assessment (including 68Ga PET performed as part of the
                  diagnostic procedure) is strongly recommended.

          5. Adequate lab parameters within 2 weeks prior to enrollment:

               -  Serum creatinine ≤ 150 μmol/L

               -  Calculated CrCl or measured GFR ≥ 30 mL/min (measured GFR may be done within 4
                  weeks prior to enrollment)

               -  Haemoglobin ≥ 90 g/L

               -  WBC ≥ 2 x 109/L

               -  Platelets ≥ 100 x 109/L

          6. Adequate liver function tests within 2 weeks prior to enrollment:

               -  total bilirubin ≤ 5 x ULN

               -  ALT ≤ 5 x ULN

               -  AST ≤ 5 x ULN

               -  alkaline phosphatase ≤ 5 x ULN

          7. Signed informed consent

          8. Patients with extensive bone metastases (e.g. >25% of bone marrow involvement are
             eligible but requires careful monitoring of hematological reserve

          9. Subject's willingness and ability to comply with scheduled visits, treatment plans,
             laboratory tests, and other study procedures.

         10. Age ≥ 18 years.

        Exclusion Criteria:

          1. Life expectancy <12 weeks

          2. An option for curative surgical or medical therapy or local liver embolization is
             feasible

          3. Candidate for curative and/or debulking surgical resections

          4. Systemic, biologic, other radioisotope, embolization therapies within ≤4 weeks prior
             to the first dose of 177Lu.

          5. Prior radiotherapy to target lesion(s) within ≤12 weeks prior to study enrollment
             [radiotherapy to non-target lesions permitted].

          6. Prior therapy with any systemic radionuclide therapy.

          7. Radiotherapy to more than 25% of the bone marrow.

          8. Known brain metastases (unless metastases have been treated and are stable for ≥ 6
             months).

          9. Uncontrolled diabetes mellitus

         10. Co-morbidities that may interfere with delivery of 177Lu (e.g. urinary incontinence).

         11. Second cancer(s) with clinical or biochemical progression within the last 3 years.

         12. Pregnancy or breast feeding. Female subjects must be surgically sterile or
             postmenopausal, or must agree to use effective contraception during the period of
             therapy. All female subjects with reproductive potential must have a negative
             pregnancy test (serum) prior to enrolment. Male subjects must be surgically sterile or
             must agree to use effective contraception during the period of therapy. The definition
             of effective contraception will be based on the judgment of the principal investigator
             or a designated associate

         13. Other condition, illness, psychiatric condition, or laboratory abnormality that may
             increase the risk associated with study participation, 68Ga or 177Lu administration,
             or may interfere with the interpretation of study results and in the judgment of the
             investigator would make the patient inappropriate for entry into this study.