ABSTRACT
@#The introduction of peptide receptor radionuclide therapy (PRRT) to the Philippines has allowed for novel approaches in the management of neuroendocrine tumors (NETs). This case report details the management of a 66-year-old Filipino man diagnosed with metastatic pancreatic NET after biopsy and staging with Ga-68 DOTATATE PET-CT. After poor response to somatostatin analogue therapy, the patient was advised to undergo PRRT. Upon completing four cycles of PRRT with Lu-177 DOTATATE, the metastatic hepatic lesions showed resolution and the pancreatic tail tumor exhibited regression, allowing the patient to undergo surgical resection of the primary tumor. On follow-up, he was declared to be in remission with good quality of life and no imaging evidence of recurrence. The case underscores the diagnostic and therapeutic utility of radiolabeled somatostatin analogues along with the importance of a multidisciplinary approach in the management of an initially unresectable metastatic pancreatic NET
Subject(s)
Receptors, Peptide , Pancreatic Neoplasms , Neuroendocrine TumorsABSTRACT
Exploring the unknown is one of the key factors that lead to great discoveries in mankind history.With the advances in medicine and the development of new approaches towards patient care, like next-generation sequencing and patient-centered care, the need for treatments tailored to patient through personalized medicine has become more compelling. Theranostics has been introduced as a combination of a diagnostic tool and a therapeutic tool on the same vector for a specific disease, to facilitate personalized medicine. Nuclear medicine has shown the capability of providing a strong platform for this new approach through its arms, molecular imaging, and targeted molecular therapies. Though the prototype of theranostics has been practiced in Jordan since decades in the field of diagnosis and treatment of well-differentiated thyroid cancer, recently, the King Hussein Cancer Center (KHCC), a leading and comprehensive cancer center in Jordan and in the Middle East, has leaped forward to introduce the new approaches of theranostics through the nuclear medicine applications. This paper sheds the light on the most important aspects of this new theranostics practice in Jordan such as peptide receptor radionuclide therapy (PRRT) and prostate-specific membrane antigen (PSMA)–based theranostics.
Subject(s)
Humans , Arm , Diagnosis , Jordan , Membranes , Middle East , Molecular Imaging , Molecular Targeted Therapy , Nuclear Medicine , Patient Care , Patient-Centered Care , Precision Medicine , Receptors, Peptide , Theranostic Nanomedicine , Thyroid NeoplasmsABSTRACT
Pancreatic neuroendocrine neoplasms(pNENs)are the most common neuroendocrine tumors.For early local pNENs,surgery is the main therapeutic strategy and the tumor can be removed completely.But for those pNENs that cannot be surgically removed or have undergone distant metastasis,peptide receptor radionuclide therapy(PRRT)can be chosen as a first-line therapeutic strategy as pNENs overexpress somatostatin receptors.In recent years,clinical trials and studies on the use of PRRT in pNENs have been increasing rapidly.Many reports have confirmed the efficacy of 90 Y and 177 Lu-labeled somatostatin analogue in pNENs patients.
ABSTRACT
Differentiated thyroid cancer(DTC) generally carries good prognosis through standard treatment. While,it could dedifferentiate into radioiodine refractory differentiated thyroid cancer(RAIR-DTC),which progresses rapidly with high mortality and limited treatment methods. Recently,along with the increasing of studies on genetic features,signal transduction pathways and immune microenvironment of RAIR-DTC,as well as the development of new radionuclide tracers,more theoretical bases have been provided for the targeted therapy of RAIR-DTC.
ABSTRACT
PURPOSE AND METHODS: Patients with inoperable andmetastasized neuroendocrine tumors (NETs), particularly those with grades 1 and 2, usually receive treatment with somatostatin analogues (SSAs). Peptide receptor radionuclide therapy (PRRT) has gained momentum over the past two decades in patients who progress on SSAs. 177Lu-DOTATATE is currently the most widely used radiopeptide for PRRT. We reviewed the recent evidence on PRRT and the treatment of gastroentero-pancreatic neuroendocrine tumors (GEP-NETs).RESULTS: ¹⁷⁷Lu-DOTATATE can be used as neoadjuvant treatment in patients with inoperable GEP-NETs, who might be candidate for surgery after treatment and as adjuvant therapy after surgical intervention. Combination treatments of PRRT with chemotherapy or targeted agents as well as combinations of radionuclides in patients with NETs have been explored over the last few years. The majority of patients with NETs experience partial response or have disease stabilization, a small percentage has complete response, while some 30% of patients, however, will have disease progression. The safety and efficacy of retreatment with extra cycles of PRRT as salvage therapy have been evaluated in small retrospective series.CONCLUSION: Overall, there is evidence that disease control and quality of life improve significantly after 117Lu PRRT therapy. Clinical trials on this therapy are scarce, and there is a need for further studies to establish proper management guidelines.
Subject(s)
Humans , Disease Progression , Drug Therapy , Lutetium , Neoadjuvant Therapy , Neuroendocrine Tumors , Nuclear Medicine , Quality of Life , Radioisotopes , Receptors, Peptide , Retreatment , Retrospective Studies , Salvage Therapy , Somatostatin , Theranostic NanomedicineABSTRACT
Peptide receptor radionuclide therapy (PRRT) is a systemic cytotoxic radiation therapy using a compound of β-emitting radionuclide chelated to a peptide for the treatment of tumor with overexpressed specific cell receptor such as somatostatin receptor subtype 2 (SSTR2) of neuroendocrine tumor (NET). Surgical resection should be performed for the curative treatment for NETs when it is feasible; however, a multi-disciplinary approach is needed when locally advanced or metastasized disease. PRRT with lutetium-177 (Lu-177)-labeled somatostatin analogues, as a new treatment modality targeting metastatic or inoperable NETs expressing the SSTR2, have been developed and successfully used for the past two decades. As Lu-177 emits both β- and γ-radiation, it has the ability as a theragnostic agent for NETs compared with only β-emitting yttrium-90 labeled PRRT. Several recent studies reported that Lu-177 gave an overall positive response and improved the patients' quality of life. To fully exploit its potential, large comparative studies are needed for the assessment of distinct efficacies of Lu-177 labeled PRRT. Additionally, for extending the indications and developing new regimens of Lu-177-based PRRT, more dedicated clinical research is required.
Subject(s)
Neuroendocrine Tumors , Quality of Life , Receptors, Peptide , Receptors, Somatostatin , SomatostatinABSTRACT
Peptide receptor radionuclide therapy (PRRT),being investigated as an effective treatment for inoperable gastroenteropancreatic neuroendocrine tumor,has gained much importance in recent years.With increasing data of clinical trials and the exploration of different radionuclides as well as the toxic and side effects,PRRT has developed continuously and play a marked role on the treatment of gastroenteropancreatic neuroendocrine tumor.