John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Peptide receptor radionuclide therapy in neuroendocrine tumours Volume 23, supplement 2, Octobre 2016


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1 Institut Claudius Regaud,
Institut Universitaire Cancer Toulouse Oncopole (IUCTO),
service de médecine nucléaire,
1 avenue Irène Joliot-Curie,
31059 Toulouse Cedex 9,
2 CHU de Toulouse,
service d’oncologie médicale digestive,
1 avenue du Pr J. Poulhès – Toulouse Cedex 9,
* Tirés à part

Neuroendocrine tumors (NETs) possess unique features including expression of peptide hormone receptors. The expression of Somatostatine receptors (SST) on tumor cells is widely used in clinical practice in an imaging setting for diagnosis, extension and prognosis evaluation. Targeting SST with Radiolabeled isotopes, namely Peptide Radiolabeled Radio Nucleide Therapy or “PRRT”, is also used as therapeutic modality. After the historical 111In-DTPA-octréotide PRRT, the new generation of PRRT includes 90Yttrium as well as 177Lutetium-based treatment of NETs, with enhanced efficacy. The objective response rate with these new PRRT compounds is in the range of 30-45 % in retrospective cohorts and almost 20 % in a large prospective trial, with 5 % grade 3/4 toxicity mainly hematologic toxicity and renal toxicity (mainly for 90Y based PRRT), with a lower rate of long-term toxicity. The only phase III study available nowadays (NETTER-01) has clearly demonstrated the ability of 177Lutetium-based PRRT to improve progression free survival for advanced intestinal NETs. In clinical practice, the indications are limited to well differentiated NETs with a significant uptake and NETs with low tumor burden and slow progression are probably the optimal indication. This treatment is now available in France and must be discussed in multidisciplinary committee. However its precise role in the treatment algorithm remains to be explored. The aim of this paper is to give an overview of the fundamental principles of molecular radiotherapy and focus on PRRT for endocrine tumors.