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A Practical Guide for the Production and PET/CT Imaging of 68Ga-DOTATATE for Neuroendocrine Tumors in Daily Clinical Practice
Published on: April 17, 2019
Combination Treatment Strategies With Peptide Receptor Radionuclide Therapy: The Current Status and Potential Future
Rahul V Parghane1,2, Sandip Basu1,2
1Professor, Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe.
Abstract:
The landscape of systemic treatment for patients with neuroendocrine tumors (NET) is continuously evolving due to discovery of various molecular pathways involvement in tumor growth and the clinical availability of several therapeutic agents against these pathways. Among these agents, peptide receptor radionuclide therapy (PRRT) serves as the cornerstone for the treatment of well-differentiated metastatic/advanced NETs that express somatostatin receptors (SSTR). However, complete response and longer survival rates with progression-free disease status after PRRT are rarely observed. Therefore, a combination of PRRT with other antitumor agents exhibiting synergistic effects is necessary to augment PRRT efficacy without increasing the toxicity profile. Various combinations of PRRT with antitumor agents or surgical intervention have been employed, including somatostatin analogs (SSAs), radiosensitizing chemotherapy, cytotoxic chemotherapy, different therapeutic isotopes, transarterial radioembolization (TARE), targeted molecular drugs, immune-checkpoint inhibitors (ICIs), and neoadjuvant PRRT before surgery. This review will explore various combinations of PRRT with other antitumor agents, highlighting their fundamental mechanisms of action for synergistic effects. It will also focus on protocols for combined PRRT approaches, provide an overview of existing literature and ongoing clinical trials, discuss the future directions and perspectives, and offer insights into the practical use of combination strategies in various clinical scenarios to assist clinicians in planning effective and safe combined treatment regimens for the management of NET patients.
Insights
Combining peptide receptor radionuclide therapy (PRRT) with other treatments can improve outcomes for neuroendocrine tumor (NET) patients. This review explores synergistic combinations to enhance PRRT efficacy and patient survival.
Area of Science:
- Oncology
- Nuclear Medicine
- Medical Physics
Background:
- Systemic treatment for neuroendocrine tumors (NETs) is evolving with new molecular pathway discoveries.
- Peptide receptor radionuclide therapy (PRRT) is a key treatment for advanced NETs expressing somatostatin receptors (SSTR).
- Current PRRT efficacy is limited, necessitating combination strategies for better outcomes.
Purpose of the Study:
- To review and analyze various combination therapies with PRRT for NET management.
- To explore synergistic mechanisms and clinical protocols of combined PRRT approaches.
- To provide insights into practical application and future directions for NET treatment.
Main Methods:
- Literature review of existing studies and ongoing clinical trials on PRRT combinations.
- Analysis of fundamental mechanisms of action for synergistic effects.
- Discussion of combined PRRT protocols and clinical scenarios.
Main Results:
- PRRT is a cornerstone for advanced NETs, but complete responses are infrequent.
- Combinations with somatostatin analogs, chemotherapy, TARE, targeted drugs, and ICIs are explored.
- Synergistic effects aim to augment PRRT efficacy without increased toxicity.
Conclusions:
- Combination strategies are crucial to enhance PRRT effectiveness in NET patients.
- Further research and clinical trials are needed to optimize combined treatment regimens.
- Tailored combination approaches can improve patient management and survival rates.
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