Peptide Receptor Radionuclide Therapy in Patients With Gastroenteropancreatic Neuroendocrine Tumors

https://doi.org/10.1053/j.semnuclmed.2009.10.004Get rights and content

Somatostatin receptor imaging with [111In-DTPA0)octreotide has proven its role in the diagnosis and staging of gastroenteropancreatic neuroendocrine tumors. Treatment with radiolabeled somatostatin analogues is a promising new tool in the management of patients with inoperable or metastasized, well-differentiated neuroendocrine tumors. Symptomatic improvement may occur with all 111In, 90Y, or 177Lu-labeled somatostatin analogues that have been used for peptide receptor radionuclide therapy. The results that were obtained with [90Y-DOTA0, Tyr3]octreotide and [177Lu-DOTA0, Tyr3]octreotate are very encouraging in terms of tumor regression. Also, if kidney protective agents are used, the side effects of this therapy are few and mild, and the median duration of the therapy response for these radiopharmaceuticals is 30 and 40 months, respectively. The patients' self-assessed quality of life increases significantly after treatment with [177Lu-DOTA0, Tyr3]octreotate. Finally, compared with historical controls, there is a benefit in overall survival of several years from time of diagnosis in patients treated with [177Lu-DOTA0, Tyr3]octreotate. These data compare favorably with the limited number of alternative treatment approaches. If more widespread use of peptide receptor radionuclide therapy can be guaranteed, such therapy may well become the therapy of first choice in patients with metastasized or inoperable gastroenteropancreatic neuroendocrine tumors.

Section snippets

Somatostatin Receptor–Based Radionuclide Therapy

Gastroenteropancreatic neuroendocrine tumors (GEPNETs), which comprise functioning and nonfunctioning endocrine pancreatic tumors and carcinoids, are usually slow-growing. When metastasized, treatment with somatostatin analogues results in reduced hormonal overproduction and symptomatic relief in most cases. Treatment with somatostatin analogues is however seldom successful in terms of tumor size reduction.2, 3, 4

A new treatment modality for patients with inoperable or metastasized endocrine

Conclusions

Treatment with radiolabeled somatostatin analogues is a promising new tool in the management of patients with inoperable or metastasized neuroendocrine tumors. Symptomatic improvement may occur with all 111In, 90Y, or 177Lu-labeled somatostatin analogues that have been used for PRRT. The results that were obtained with [90Y-DOTA0, Tyr3]octreotide and [177Lu-DOTA0, Tyr3]octreotate are very encouraging in terms of tumor regression. Also, if kidney protective agents are used, the side effects of

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