New Insights in PRRT: Lessons From 2021
Giulia Puliani1,2, Alfonsina Chiefari1, Marilda Mormando1
1Oncological Endocrinology Unit, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Regina Elena National Cancer Institute, Rome, Italy.
Abstract:
Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs has been used for over two decades for the treatment of well-differentiated neuroendocrine tumors (NETs), and the publication of the NETTER-1 trials has further strengthened its clinical use. However, many aspects of this treatment are still under discussion. The purpose of this review is to collect and discuss the new available evidence, published in 2021, on the use of 177Lu-Oxodotreotide (DOTATATE) or 90Y-Edotreotide (DOTATOC) in adult patients with NETs focusing on the following hot topics: 1) PRRT use in new clinical settings, broaden its indications; 2) the short- and long-term safety; and 3) the identification of prognostic and predictive factors. The review suggests a possible future increase of PRRT applications, using it in other NETs, as a neoadjuvant treatment, or for rechallenge. Regarding safety, available studies, even those with long follow-up, supported the low rates of adverse events, even though 1.8% of treated patients developed a second malignancy. Finally, there is a lack of prognostic and predictive factors for PRRT, with the exception of the crucial role of nuclear imaging for both patient selection and treatment response estimation.
Insights
Peptide receptor radionuclide therapy (PRRT) shows promise for neuroendocrine tumors (NETs) with expanding applications and good safety profiles. Further research is needed to identify prognostic factors for this advanced cancer treatment.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiopharmaceutical Therapy
Background:
- Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs is an established treatment for well-differentiated neuroendocrine tumors (NETs).
- The NETTER-1 trial has reinforced the clinical utility of PRRT.
- Ongoing discussions persist regarding various aspects of PRRT, necessitating a review of recent evidence.
Purpose of the Study:
- To review and discuss new evidence published in 2021 concerning PRRT with 177Lu-Oxodotreotide (DOTATATE) or 90Y-Edotreotide (DOTATOC) in adult NET patients.
- To focus on emerging clinical applications, safety data, and prognostic/predictive factors.
- To consolidate current understanding and guide future research and clinical practice.
Main Methods:
- Systematic review of literature published in 2021 focusing on PRRT for NETs.
- Analysis of studies investigating novel indications, safety outcomes (short- and long-term), and prognostic/predictive factors.
- Synthesis of evidence related to 177Lu-DOTATATE and 90Y-DOTATOC therapies.
Main Results:
- PRRT may see expanded use in new clinical settings, including other NET types, neoadjuvant therapy, and retreatment (rechallenge).
- Available studies indicate a favorable safety profile with low adverse event rates, though 1.8% of patients developed a second malignancy.
- A significant gap exists in identifying prognostic and predictive factors, with nuclear imaging playing a key role in patient selection and response assessment.
Conclusions:
- PRRT is a valuable therapeutic option for NETs with potential for broadened indications and a generally safe profile.
- Further investigation is required to establish robust prognostic and predictive biomarkers for PRRT.
- Nuclear imaging remains critical for optimizing PRRT patient selection and monitoring treatment efficacy.
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