Abstract
Neuroendocrine neoplasms make up a heterogeneous group of tumors with inter-patient and intra-patient variabilities. Molecular imaging can help to identify and characterize neuroendocrine tumors (NETs). Furthermore, imaging and treatment with novel theranostics agents offers a new, tailored approach to managing NETs. Recent advances in the management of NETs aim to enhance the effectiveness of targeted treatment with either modifications of known substances or the development of new substances with better targeting features. There have been several attempts to increase the detectability of NET lesions via positron emission tomography (PET) imaging and improvements in pretreatment planning using dosimetry. Especially notable is PET imaging with the radionuclide Copper-64. Increasing interest is also being paid to theranostics of grade 3 and purely differentiated NETs, for example, via targeting of the C-X-C motif chemokine receptor 4 (CXCR4). The aim of this review is to summarize the most relevant recent studies, which present promising new agents in molecular imaging and therapy for NETs, novel combination therapies and new applications of existing molecular imaging modalities in nuclear medicine.
Highlights
Current Knowledge and Aims of this ReviewIn modern oncology, imaging is necessary for treatment planning, tumor staging and follow-up
In the past few years, peptide receptor radionuclide therapy (PRRT) has gained increasing attention since the randomized prospective phase III trial NETTER-1 showed, in patients with midgut neuroendocrine tumors (NETs), clear clinical benefits from PRRT with [177Lu]Lu-DOTA-TATE compared to the somatostatin receptor analog Sandostatin® LAR: progression-free survival (PFS) with the median not reached at the time of the primary endpoint analysis vs. 8.4 months (p < 0.001), better overall response (18% vs. 3%) and a presumably longer overall survival (OS) [16]
Different tumor-specific biological indicators in NETs have been developed in molecular imaging to show their activity in vivo and post-therapeutic changes over time
Summary
In modern oncology, imaging is necessary for treatment planning, tumor staging and follow-up. In the past few years, PRRT has gained increasing attention since the randomized prospective phase III trial NETTER-1 showed, in patients with midgut NET, clear clinical benefits from PRRT with [177Lu]Lu-DOTA-TATE compared to the somatostatin receptor analog Sandostatin® LAR: progression-free survival (PFS) with the median not reached at the time of the primary endpoint analysis vs 8.4 months (p < 0.001), better overall response (18% vs 3%) and a presumably longer overall survival (OS) (median not reached, p = 0.004) [16] Another current randomizing phase III study is the multicenter COMPETE trial, which aims to compare survival in GEP-NET (gastro-entero-pancreatic neuroendocrine tumors) patients after PRRT and Everolimus (COMPETE study, ClinicalTrials.gov Identifier (CI): NCT03049189). This review will present promising new agents in the molecular imaging and therapy of NETs, novel combination therapies and new applications of existing molecular imaging modalities in nuclear medicine
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