The somatostatin receptor, which is overexpressed by many neuroendocrine tumors, is a well-known target for molecular imaging and peptide receptor radionuclide therapy. Recently, 57 Co-labeled DOTA-TOC, an octreotide analog, was shown to have the highest affinity yet found for somatostatin receptor subtype 2. The aim of this study was to evaluate the biologic effects of novel cobalt-labeled octreotide analogs targeting the somatostatin receptor to identify promising candidates for molecular imaging and Auger electron-based radionuclide therapy. Methods: Cobalt-labeled DOTATATE, DOTATOC, and DOTANOC were prepared with 57 Co or 58m Co for SPECT or Auger electron-based therapy, respectively. The cellular uptake and intracellular distribution of the radioligands were characterized with the pancreatic tumor cell line AR42J in vitro, including assessment of the therapeutic effects of 58m Co-DOTATATE via DNA double-strand break and proliferation assays. Comparisons with the therapeutic effects of 111 In-and 177 Lu-DOTATATE were also performed. Tumor uptake and normal tissue uptake were characterized in a subcutaneous pancreatic tumor mouse model. Results: All 3 cobalt-conjugated peptides resulted in time-dependent and receptor-specific uptake, with a high level (≥88%) of cellular internalization in vitro of the total cell-associated radioactivity. The DNA double-strand break yield showed a dose-dependent increase with activity, whereas cell survival showed a dose-dependent decrease. 58m Co-DOTATATE was significantly more efficient in cell killing per cumulated decay than 111 In-and 177 Lu-DOTATATE. The in vivo pharmacokinetic studies showed a high level of receptor-specific tumor uptake. Conclusion: All cobalt-labeled radioligands showed a high level of receptor-specific uptake both in vitro and in vivo in tumorbearing mice. Furthermore, 58m Co-DOTATATE showed considerable therapeutic effects in vitro and, thus, could be an effective agent for eradicating disseminated tumor cells and micrometastases. Thesomat ostatin receptor, which is overexpressed by many neuroendocrine tumors, is a well-known target for molecular imaging (i.e., PET and SPECT) and for peptide receptor radionuclide therapy (1,2). One of the most widely used radiopharmaceuticals for SPECT imaging of these tumors is 111 In-diethylenetriaminepentaacetic acid ( Recently, 57 Co-labeled DOTATOC was shown to have the highest affinity yet found for the somatostatin receptor subtype 2 (SSTR2) (6). Furthermore, the rate of internalization of this compound into the pancreatic tumor cell line AR42J was the highest found for any somatostatin-based radioligand. In a study by Uusijärvi et al. (7) of 59 therapeutic radionuclides (a, b, and Auger electron emitters), the Auger electron emitter 58m Co was the radionuclide that resulted in the second highest theoretic tumor-to-normal tissue dose rate ratio. Therefore, the therapeutic potency of the 58m Co radionuclide and the remarkable obtainable internalization rates and affinities for SSTR2-expressing tumor cells mak...