Treatment of Gastroenteropancreatic Neuroendocrine Tumors with Peptide Receptor Radionuclide Therapy

• Published in: Neuroendocrinology Vol. 97; no. 1; pp. 74 - 85
• Main Authors: van Vliet, Esther I., Teunissen, Jaap J.M., Kam, Boen L.R., de Jong, Marion, Krenning, Eric P., Kwekkeboom, Dik J.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.02.2013
• Subjects: Carcinoma, Neuroendocrine - therapy; Gastrointestinal Neoplasms - therapy; Humans; Pancreatic Neoplasms - therapy; Radioisotopes - therapeutic use; Radiopharmaceuticals - therapeutic use; Radiotherapy via SSTR; Receptors, Peptide - metabolism; Somatostatin analogs; Gastroenteropancreatic neuroendocrine tumors; Radiolabeled somatostatin analogs; Peptide receptor radionuclide therapy
• ISBN: 9783318022964; 3318022969
• ISSN: 0028-3835; 1423-0194
• DOI: 10.1159/000335018

The primary treatment of gastroenteropancreatic neuroendocrine tumors (GEPNETs) is surgery with curative intent or debulking of the tumor mass. In case of metastatic disease, cytoreductive options are limited. A relatively new therapeutic modality, peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs, is currently available in a number of mostly European centers. Complete and partial responses obtained after treatment with [ 90 Y-DOTA⁰,Tyr 3 ]octreotide are in the same range as after treatment with [ 177 Lu-DOTA⁰,Tyr 3 ]octreotate (i.e. 10–30%). However, significant nephrotoxicity has been observed after treatment with [ 90 Y-DOTA⁰,Tyr 3 ]octreotide. Options to improve PRRT may include combinations of radioactive labeled somatostatin analogs, intra-arterial administration, and the use of radiosensitizing drugs combined with PRRT. Other therapeutic applications of PRRT may include additional therapy cycles in patients with progressive disease after benefit from initial therapy, PRRT in adjuvant or neoadjuvant setting, or PRRT combined with new targeted therapies, such as sunitinib or everolimus. Randomized clinical trials comparing PRRT with other treatment modalities, or comparing various radioactive labeled somatostatin analogs should be undertaken to determine the best treatment options and treatment sequelae for patients with GEPNETs.