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  • Review Article
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Peptide-receptor radionuclide therapy for endocrine tumors

Nature Reviews Endocrinology volume 5, pages 382–393 (2009)Cite this article

Abstract

Peptide-receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs is a promising option for the treatment of somatostatin-receptor-positive endocrine tumors. Treatment with somatostatin analogs labeled with 111In, 90Y or 177Lu can result in symptomatic improvement, although tumor remission is seldom achieved with 111In-labeled analogs. In this Review, the findings of several studies on the use of PRRT for endocrine tumors are evaluated. Large variation in the antitumor effects of 90Y-octreotide was reported between studies: an objective response (≥50% tumor regression) was achieved in 9–33% of patients. After treatment with 177Lu-octreotate, an objective response was achieved in 29% of patients and a minor response (25–50% tumor regression) was achieved in 16% of patients; stable disease was present in 35% of patients. Treatment with 177Lu-octreotate resulted in a survival benefit of several years and markedly improved quality of life. Serious, delayed adverse effects were rare after PRRT. Although randomized, clinical trials have not yet been performed, data on the use of PRRT compare favorably with those from other treatment approaches, such as chemotherapy. If these results can be replicated in large, controlled trials, PRRT might become the preferred option in patients with metastatic or inoperable gastroenteropancreatic neuroendocrine tumors.

Key Points

  • Peptide-receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs is a promising treatment modality for patients with somatostatin-receptor-positive gastroenteropancreatic neuroendocrine tumors

  • 177Lu-octreotate resulted in tumor remission in 46% and stable disease in 35% of patients; a median time to progression of 40 months and a survival benefit of several years was indicated

  • PRRT is generally well tolerated if treating physicians adhere to dose limits and renal protection is administered

  • PRRT can also be effective for patients with nongastroenteropancreatic tumors, such as non-radioiodine-avid thyroid carcinoma and paraganglioma; however, further studies are needed to determine PRRT's role in this setting

  • Studies are ongoing to improve the antitumor effects of PRRT, reduce its adverse effects, increase patients' long-term survival prospects, and improve their quality of life

  • PRRT might become the preferred option for patients with progressive gastroenteropancreatic neuroendocrine tumors if these data can be confirmed

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Figure 1: Improved tumor uptake of 177Lu-octreotate versus that of 111In-octreotide.
Figure 2: Patient with a carcinoid tumor and liver metastases.
Figure 3: Overall survival of patients with GEPNETs.

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Acknowledgements

The authors thank personnel from the departments of Nuclear Medicine and Internal Medicine of the Erasmus Medical Centre for their expert help and cooperation, especially research nurses Daniëlle Verwaal, Agnes van Uden and Els Montijn.

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  1. Department of Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands

    Martijn van Essen, Eric P. Krenning, Boen L. R. Kam, Marion de Jong, Roelf Valkema & Dik J. Kwekkeboom

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  1. Martijn van Essen
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Correspondence to Martijn van Essen.

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Competing interests

E. P. Krenning declares associations with the following companies: BioSynthema (consultant, stock holder/director, patent holder/applicant), Covidien (consultant, grant/research support) and Novartis (grant/research support, patent holder/applicant).

D. J. Kwekkeboom declares an association with the following company: BioSynthema (stock holder/director).

M. van Essen, B. L. R. Kam, M. de Jong, and R. Valkema declare no competing interests.

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van Essen, M., Krenning, E., Kam, B. et al. Peptide-receptor radionuclide therapy for endocrine tumors. Nat Rev Endocrinol 5, 382–393 (2009). https://doi.org/10.1038/nrendo.2009.105

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