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Review
. 2024 May;26(5):538-550.
doi: 10.1007/s11912-024-01526-5. Epub 2024 Apr 6.

Radionuclide Theranostics in Neuroendocrine Neoplasms: An Update

Martina Di Franco  1 , Lucia Zanoni  2 , Emilia Fortunati  2 , Stefano Fanti  3   2 , Valentina Ambrosini  3   2
Affiliations
Review

Radionuclide Theranostics in Neuroendocrine Neoplasms: An Update

Martina Di Franco et al. Curr Oncol Rep. 2024 May.

Abstract

Purpose of review: This paper aims to address the latest findings in neuroendocrine tumor (NET) theranostics, focusing on new evidence and future directions of combined diagnosis with positron emission tomography (PET) and treatment with peptide receptor radionuclide therapy (PRRT).

Recent findings: Following NETTER-1 trial, PRRT with [177Lu]Lu-DOTATATE was approved by FDA and EMA and is routinely employed in advanced G1 and G2 SST (somatostatin receptor)-expressing NET. Different approaches have been proposed so far to improve the PRRT therapeutic index, encompassing re-treatment protocols, combinations with other therapies and novel indications. Molecular imaging holds a potential added value in characterizing disease biology and heterogeneity using different radiopharmaceuticals (e.g., SST and FDG) and may provide predictive and prognostic parameters. Response assessment criteria are still an unmet need and new theranostic pairs showed preliminary encouraging results. PRRT for NET has become a paradigm of modern theranostics. PRRT holds a favorable toxicity profile, and it is associated with a prolonged time to progression, reduction of symptoms, and improved patients' quality of life. In light of further optimization, different new strategies have been investigated, along with the development of new radiopharmaceuticals.

Trial registration: ClinicalTrials.gov NCT03454763 NCT04917484.

Keywords: NET; Neuroendocrine tumors; PET; PRRT; Theranostics.

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Conflict of interest statement

Martina Di Franco, Lucia Zanoni, and Emilia Fortunati have no conflict of interest. Valentina Ambrosini received honoraria from ESMO/EANM/ESMIT/Elma Academy/AAA/Cineca; non-financial disclosures: she is member of ENETS Advisory board, EANM Oncology and Theranostic committee, ITANET scientific committee, ESMO faculty for NET. Stefano Fanti received honoraria from AAA, Amgen, Bayer, Debio, Immedica, Janssen, Novartis, and Telix.

Figures

Fig. 1
Fig. 1
Patient with pancreatic NET G1 (Ki-67, 1.7%) treated with 4 cycles of PRRT with [177Lu]Lu-DOTATATE. Baseline [68 Ga]Ga-DOTANOC PET/CT (a, b) showed high uptake in multiple liver lesions. [68 Ga]Ga-DOTANOC PET/CT after PRRT (c, d) documented reduced lesions’ number and reduced intensity of uptake, in keeping with partial response to PRRT
See this image and copyright information in PMC

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