Peptide receptor radionuclide therapy (PRRT) for GEP-NETs

Peptide receptor radionuclide therapy (PRRT) with radiolabelled somatostatin analogues plays an increasing role in the treatment of patients with inoperable or metastasised gatroenteropancreatic neuroendocrine tumours (GEP-NETs). Y-90-DOTATOC and Lu-177-DOTATATE are the most used radiopeptides for PRRT with comparable tumour response rates (about 15-35%). The side effects of this therapy are few and mild. However, amino acids should be used for kidney protection, especially during infusion of Y-90-DOTATOC. Options to improve PRRT may include combinations of radioactive labelled somatostatin analogues and the use of radio-sensitising drugs combined with PRRT. Other therapeutic applications of PRRT may include intra-arterial administration, neoadjuvant treatment and additional PRRT cycles in patients with progressive disease, who have benefited from initial therapy.Considering the mild side-effects, PRRT may well become the first-line therapy in patients with metastasised or inoperable GEP-NETs if more widespread use of PRRT can be accomplished. (C) 2013 Elsevier Ltd. All rights reserved.