Abstract
Radionuclide therapy for neuroendocrine tumors is a form of systemic radiotherapy that allows the administration of targeted radionuclides into tumor cells that express a large quantity of somatostatin receptors. The two most commonly used radio-peptides for radionuclide therapy in neuroendocrine tumors are 90Y-DOTATOC and 177Lu-DOTATATE. Radio-peptides have been used for several years in the treatment of advanced neuroendocrine tumors. Recently, the randomized Phase III study NETTER-1 compared177Lu-DOTATATE versus high-dose (double-dose) octreotide LAR in patients with metastatic midgut neuroendocrine tumors, and demonstrated its efficacy in this setting. Strong signals in favor of efficiency seem to exist for other tumors, in particular for pancreatic and pulmonary neuroendocrine tumors. This focus on radionuclide therapy in gastroenteropancreatic and pulmonary neuroendocrine tumors addresses the treatment modalities, the validated and potential indications, and the safety of the therapy.
Highlights
Neuroendocrine tumors (NETs) are rare tumors characterized by the ability to synthesize, store, and secrete a variety of neuro-amines and peptides that can lead to secretory syndrome
The number of treatment interruptions related to its toxicity was 59 in the everolimus arm versus 0 in the peptide receptor radionuclide therapy (PRRT) arm [22]. These findings suggest that PRRT is effective in controlling disease in patients who are not amenable to surgical treatment, as well as less toxicity (Table 2, [6,9,10,11,12,13,21,23,24,25]) compared to other treatment alternatives
The development of myelodysplastic syndrome or leukemia has been reported between 30 and 70 months after treatment with PRRT [39]. These results suggest an imputability of alkylating agents associated with PRRT as only 1% of the patients treated only by alkylating chemotherapy developed myelodysplastic syndrome
Summary
Neuroendocrine tumors (NETs) are rare tumors characterized by the ability to synthesize, store, and secrete a variety of neuro-amines and peptides that can lead to secretory syndrome. Since 1992, peptide receptor radionuclide therapy (PRRT) has been developed as a new therapeutic option in metastatic or non-resectable NET This treatment corresponds to a form of systemic radiotherapy that allows targeted administration of systemic radiopharmaceuticals nucleides to tumor cells expressing high levels of somatostatin receptor (SSTR). The NETTER-1 Phase III Randomized Trial validated this treatment option by confirming its low toxicity and its effectiveness in tumor control Following these results, 177 Lu-DOTATATE was approved by the US Food and Drug Administration in 2018 and the European Medicines Agency in 2017 for the treatment of gastroenteropancreatic NETs that are well differentiated and obtain a prescription authorization in France in metastatic midgut NETs [2]. Due to the emission of gamma rays, the 177 Lu can be used for dosimetry and monitoring of tumor response [4]
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