The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours

• Published in: European journal of nuclear medicine and molecular imaging Vol. 40; no. 5; pp. 800 - 816
• Main Authors: Zaknun, John J., Bodei, L., Mueller-Brand, J., Pavel, M. E., Baum, R. P., Hörsch, D., O’Dorisio, M. S., O’Dorisiol, T. M., Howe, J. R., Cremonesi, M., Kwekkeboom, D. J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2013; Springer Nature B.V
• Subjects: Cancer; Cardiology; Endocrine system; Europe; Follow-Up Studies; Guidelines; Humans; Imaging; International Agencies; Kidney - physiology; Kidney - radiation effects; Medicine; Medicine & Public Health; Molecular Targeted Therapy - adverse effects; Molecular Targeted Therapy - methods; Nervous system; Neuroendocrine Tumors - metabolism; Neuroendocrine Tumors - radiotherapy; Nuclear Energy; Nuclear Medicine; Oncology; Orthopedics; Peptides; Quality Control; Radiology; Radiometry; Radiopharmaceuticals - adverse effects; Radiopharmaceuticals - therapeutic use; Radiotherapy - adverse effects; Radiotherapy - methods; Receptors, Peptide - metabolism; Societies, Scientific; Europe; Peptide receptor radionuclide therapy; PRRNT, neuroendocrine tumours, guideline/s, renal protection; PRRNT
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-012-2330-6

Peptide receptor radionuclide therapy (PRRNT) is a molecularly targeted radiation therapy involving the systemic administration of a radiolabelled peptide designed to target with high affinity and specificity receptors overexpressed on tumours. PRRNT employing the radiotagged somatostatin receptor agonists
90
Y-DOTATOC ([
90
Y-DOTA
0
,Tyr
3
]-octreotide) or
177
Lu-DOTATATE ([
177
Lu-DOTA
0
,Tyr
3
,Thr
8
]-octreotide or [
177
Lu-DOTA
0
,Tyr
3
]-octreotate) have been successfully used for the past 15 years to target metastatic or inoperable neuroendocrine tumours expressing the somatostatin receptor subtype 2. Accumulated evidence from clinical experience indicates that these tumours can be subjected to a high absorbed dose which leads to partial or complete objective responses in up to 30 % of treated patients. Survival analyses indicate that patients presenting with high tumour receptor expression at study entry and receiving
177
Lu-DOTATATE or
90
Y-DOTATOC treatment show significantly higher objective responses, leading to longer survival and improved quality of life. Side effects of PRRNT are typically seen in the kidneys and bone marrow. These, however, are usually mild provided adequate protective measures are undertaken. Despite the large body of evidence regarding efficacy and clinical safety, PRRNT is still considered an investigational treatment and its implementation must comply with national legislation, and ethical guidelines concerning human therapeutic investigations. This guidance was formulated based on recent literature and leading experts’ opinions. It covers the rationale, indications and contraindications for PRRNT, assessment of treatment response and patient follow-up. This document is aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRNT and to deliver the treatment in a safe and effective manner. This document is largely based on the book published through a joint international effort under the auspices of the Nuclear Medicine Section of the International Atomic Energy Agency.