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Peptide Receptor Radionuclide Therapy

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Clinical Nuclear Medicine

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Abstract

Peptide receptor radionuclide therapy (PRRT) uses, as a therapeutic target, the overexpression of somatostatin receptors (SSTRs) in neuroendocrine tumours (NETs). The radiopharmaceutical contains generally a somatostatin analogue, which binds somatostatin receptors, and a linking molecule (chelator), which binds the radioisotope: most commonly Lutetium-177 or Yttrium-90.

SSTR imaging must be performed in patients before starting PRRT to prove the SSTR-positive status of the tumour. Furthermore, [18F]F-FDG-PET may be useful to evaluate the metabolic activity of the tumour sites and can help to decide whether PRRT should be performed as a monotherapy or combined with more aggressive treatment. Required for the PRRT are good general condition, sufficient bone marrow function and renal function.

PRRT is indicated as a palliative treatment in patients with non-resectable metastatic NET with good SSTR expression if there is progression of disease after first-line treatment. Even in this late stage of disease, the majority of patients achieve a stable disease (5–77%) or objective response (14–75%). PRRT has been shown to be especially effective in patients with slow-growing, G1–G2 (well- or moderately differentiated) gastroenteropancreatic neuroendocrine tumours.

Common subacute adverse events after PPRT administration are fatigue, mild alopecia, hypo−/azoospermia, mild/moderate renal impairment and hematological abnormalities (11% severe haematotoxicity). Severe late toxicity such as myelodysplastic syndrome (2.35% of patients), acute leukaemia (1.1%) and nephrotoxicity (1.5%) is rare. Nephrotoxicity is more common in patients treated with Yttrium-90-labelled somatostatin analogues than with Lutetium-177 ones. Generally, PRRT is mostly well tolerated with rarely occurring severe adverse events.

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Authors and Affiliations

  1. Department of Radiology, St. Marien Hospital, Bonn, Germany

    Anna Yordanova

  2. Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany

    Anna Yordanova

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  1. Anna Yordanova
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Editors and Affiliations

  1. Department of Nuclear Medicine, Klinikum Westfalen - Knappschaftskrankenhaus Academic teaching hospital of the Ruhr University, Dortmund, Nordrhein-Westfalen, Germany

    Hojjat Ahmadzadehfar

  2. Department of Nuclear Medicine, Beta Klinik Bonn, Bonn, Germany

    Hans-Jürgen Biersack

  3. Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, NY, USA

    Leonard M. Freeman

  4. Albert Einstein College of Medicine, Bronx, NY, USA

    Lionel S. Zuckier

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Yordanova, A. (2020). Peptide Receptor Radionuclide Therapy. In: Ahmadzadehfar, H., Biersack, HJ., Freeman, L., Zuckier, L. (eds) Clinical Nuclear Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-39457-8_32

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