Treatment with radionuclide-labeled peptides in refractory meningiomas: Updated review and clinical perspectives

The use of theragnostics in nuclear medicine has significantly advanced, particularly peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors. Meningiomas often overexpress somatostatin receptors (SSTR), making them potential candidates for PRRT. However, the lack of large-scale standardized trials limits its clinical application. Meningiomas are the most common primary intracranial tumors; the treatment of choice for which is surgical resection or, if that's not possible, radiotherapy. However, some cases are refractory to standard treatments, leading to the exploration of other therapeutic options, such as targeted therapy with radioligands. Studies have demonstrated promising results with [¹⁷⁷Lu]Lu-DOTATATE in meningiomas expressing SSTR2, improving progression-free survival (PFS) in refractory cases. Current evidence suggests that PRRT is a viable option for refractory meningiomas with high SSTR expression. However, further clinical trials are needed to establish standardized protocols, optimize patient selection criteria, and explore combination therapy strategies to improve outcomes. This review highlights the mechanisms, clinical applications, and future perspectives of [¹⁷⁷Lu]Lu-DOTATATE in meningiomas, providing insights into its expanding role in this pathology.