The State of Peptide Receptor Radionuclide Therapy and Its Sequencing among Current Therapeutic Options for Gastroenteropancreatic Neuroendocrine Tumors

• Published in: Neuroendocrinology Vol. 111; no. 11; p. 1086
• Main Authors: Raymond, Lauren M, Korzun, Tetiana, Kardosh, Adel, Kolbeck, Kenneth J, Pommier, Rodney, Mittra, Erik S
• Format: Journal Article
• Language: English
• Published: Switzerland 01.10.2021
• Subjects: Humans; Intestinal Neoplasms - drug therapy; Intestinal Neoplasms - radiotherapy; Intestinal Neoplasms - surgery; Intestinal Neoplasms - therapy; Neuroendocrine Tumors - drug therapy; Neuroendocrine Tumors - radiotherapy; Neuroendocrine Tumors - surgery; Neuroendocrine Tumors - therapy; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - radiotherapy; Pancreatic Neoplasms - surgery; Pancreatic Neoplasms - therapy; Radioisotopes - therapeutic use; Receptors, Peptide - therapeutic use; Stomach Neoplasms - drug therapy; Stomach Neoplasms - radiotherapy; Stomach Neoplasms - surgery; Stomach Neoplasms - therapy; 177Lu-dodecanetetraacetic acid0-Tyr3]octreotate; Gastroenteropancreatic neuroendocrine tumor; Receptors; Peptide; Peptide receptor radionuclide therapy; Neuroendocrine tumors
• ISSN: 1423-0194
• DOI: 10.1159/000516015

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are the most common form of neuroendocrine neoplasia, but there is no current consensus for the sequencing of approved therapies, particularly with respect to peptide receptor radionuclide therapy (PRRT). This comprehensive review evaluates the data supporting approved therapies for GEP-NETs and recommendations for therapeutic sequencing with a focus on how PRRT currently fits within sequencing algorithms. The current recommendations for PRRT sequencing restrict its use to metastatic, inoperable, progressive midgut NETs; however, this may change with emerging data to suggest that PRRT might be beneficial as neoadjuvant therapy for inoperable tumors, is more tolerable than other treatment modalities following first-line standard dose somatostatin analogs, and can be used as salvage therapy after disease relapse following prior successful cycles of PRRT. PRRT has also been shown to reduce tumor burden, improve quality of life, and prolong the time to disease progression in a broad spectrum of patients with GEP-NETs. As the various potential benefits of PRRT in GEP-NET therapy continues to expand, it is necessary to review and critically evaluate our treatment algorithms for GEP-NETs.