Radioligand therapy [RLT; e.g. lutetium (177Lu) oxodotreotide (Lutathera®)] is an established treatment option for progressive, well-differentiated, grade 1–2 gastro-entero-pancreatic neuroendocrine tumours (GEP-NETs).

In clinical practice, however, RLT is underutilised, and the optimal sequence of treatment is undefined; successful treatment of GEP-NETs requires clear practical guidance on managing the patient therapeutic journey and optimisation of RLT.

In this article, we analyse four key areas where (in the opinion of Italian experts) practical clarification of RLT guidelines is needed, including: (1) defining tumour progression prior to RLT; (2) RLT impact on bone metastases and/or high hepatic tumour burden; (3) optimal protocols for monitoring tumour response; and (4) organisational issues related to RLT use.

The development of a diagnostic-therapeutic care pathway (DTCP) is recommended in order to provide systematic guidance being personalised according to clinical and psychosocial needs of each patient.

A DTCP may clarify the diagnostic, therapeutic and post-treatment monitoring process and improve the coordination of care in patients with GEP-NETs.