New Insights in PRRT: Lessons From 2021

Abstract

Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs has been used for over two decades for the treatment of well-differentiated neuroendocrine tumors (NETs), and the publication of the NETTER-1 trials has further strengthened its clinical use. However, many aspects of this treatment are still under discussion. The purpose of this review is to collect and discuss the new available evidence, published in 2021, on the use of 177Lu-Oxodotreotide (DOTATATE) or 90Y-Edotreotide (DOTATOC) in adult patients with NETs focusing on the following hot topics: 1) PRRT use in new clinical settings, broaden its indications; 2) the short- and long-term safety; and 3) the identification of prognostic and predictive factors. The review suggests a possible future increase of PRRT applications, using it in other NETs, as a neoadjuvant treatment, or for rechallenge. Regarding safety, available studies, even those with long follow-up, supported the low rates of adverse events, even though 1.8% of treated patients developed a second malignancy. Finally, there is a lack of prognostic and predictive factors for PRRT, with the exception of the crucial role of nuclear imaging for both patient selection and treatment response estimation.

Preclinical Evaluation of [155/161Tb]Tb-Crown-TATE—A Novel SPECT Imaging Theranostic Agent Targeting Neuroendocrine Tumours

“…The majority of advanced, progressive NETs show overexpression of somatostatin receptors (SSTRs) on the cell surface and are therefore attractive targets for radionuclide imaging and therapy [ 1 , 2 ]. In humans, SSTRs are comprised of five subtypes (SSTR1-5), which are expressed in numerous organ systems including the gastrointestinal tract, pancreas, lungs, and renal organs.…”

“…Peptide receptor radionuclide therapy (PRRT) with complementary diagnostic imaging is a highly effective approach for the treatment of advanced neuroendocrine tumours (NETs) and has shown high response rates in patients previously refractory to conventional somatostatin therapy [ 1 , 2 , 3 ]. This approach involves the systemic administration of therapeutic radiopharmaceuticals which enable the selective localisation of ionising radiation to tumour sites through peptide-based molecular recognition of cell-surface receptors.…”

Effective Treatment of SSTR2-Positive Small Cell Lung Cancer Using 211At-Containing Targeted α-Particle Therapy Agent Which Promotes Endogenous Antitumor Immune Response

“…Although small cell lung cancer (SCLC) is highly sensitive to chemotherapeutic agents at the beginning of treatment, it is characterized by rapid recurrence, early widespread metastasis, and poor prognosis. , As the basic treatment of SCLC, systemic chemotherapy has reached the therapeutic plateau, and more effective treatment plans for SCLC are urgently needed. , Highly expressed somatostatin receptor (SSTR) on the surface of most SCLC cells provides an important target for nuclear medicine polypeptide-receptor-mediated radionuclide therapy (PRRT). PRRT targeting SSTR offers hope for patients with advanced SCLC who have lost the opportunity for surgery and failed to respond to other therapies. − …”

A radiomic‐ and dosiomic‐based machine learning regression model for pretreatment planning in 177Lu‐DOTATATE therapy

“…Molecular radiotherapy (MRT) uses radioactive sources to treat cancer 1–3 by delivering a radioactive radioisotope directly to the tumorous area 4 . In MRT prior to treatment, a planning agent is administered either for dosimetry or patient selection purposes 5,6 .…”

“…These radiodosiomic features can potentially provide information on any possible disease recurrence and may be highly useful in clinical decision-making, especially regarding dose escalation issues. INTRODUCTION Molecular radiotherapy (MRT) uses radioactive sources to treat cancer [1][2][3] by delivering a radioactive radioisotope directly to the tumorous area. 4 In MRT prior to treatment, a planning agent is administered either for dosimetry or patient selection purposes.…”