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Der Nuklearmediziner 2019; 42(01): 46-58
DOI: 10.1055/a-0807-3499
Theranostik
© Georg Thieme Verlag KG Stuttgart · New York

Theranostik von neuroendokrinen Tumoren

Theranostics of neuroendocrine tumors
Lisa Bodei
1   Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
,
Wolfgang A. Weber
2   Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
› Author Affiliations
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Publication History

Publication Date:
25 April 2019 (online)

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Zusammenfassung

Neuroendokrine Tumore sind eine heterogene Gruppe von Erkrankungen, die häufig spezifische Rezeptoren, Transporter und Enzyme exprimieren, die für die nuklearmedizinische Bildgebung und Therapie eingesetzt werden können. Insbesondere radioaktiv markierte Liganden der Somatostatinrezeptoren haben sich dabei als effektiv erwiesen. Die medikamentöse Therapie von neuroendokrinen Tumoren ist abhängig vom histologischen Differenzierungsgrad und der Tumorlokalisation. Durch randomisierte Studien wurde die Effektivität von Somatostatinanaloga nicht nur für die Behandlung von Symptomen, sondern auch zur Verlangsamung des Tumorwachstums, nachgewiesen. Der mTOR-Inhibitor Everolimus verlangsamt im Vergleich zu Placebo das Wachstum von neuroendokrinen Tumoren der Lunge, des Pankreas und des Gastrointestinaltrakts. Für den Multikinase-Inhibitor Sunitinib, der die tumorinduzierte Angiogenese hemmt, ist die Wirksamkeit nur für neuroendokrine Tumore des Pankreas nachgewiesen. Im Vergleich zu diesen medikamentösen Therapieansätzen kommt es durch die nuklearmedizinische Therapie mit deutlich höherer Wahrscheinlichkeit zu einem Therapieansprechen und einem längeren progressionsfreien Überleben im Vergleich zu Somatostatinanaloga. Dies wurde kürzlich auch durch eine randomisierte Studie bestätigt, die zur Zulassung von 177Lu-DOTA-TATE in Europa und den USA geführt hat. Eine randomisierte Studie, die 177Lu-DOTA-TOC mit Everolimus vergleicht, rekrutiert derzeit Patienten. Ob die Effektivität der nuklearmedizinischen Therapie durch den Einsatz von Somatostatinrezeptor-Antagonisten weiter gesteigert werden kann, wird ebenfalls in prospektiven Studien untersucht. Die Bedeutung von neuroendokrinen Tumoren für die Nuklearmedizin wird deshalb sehr wahrscheinlich weiter zunehmen.

Abstract

Neuroendocrine tumors are a heterogeneous group of diseases that frequently overexpress specific receptors, enzymes and transporters which can serve as target for nuclear imaging and therapy. Specifically, radiolabeled ligands of somatostatin receptors have been shown to be effective for imaging and radionuclide therapy of neuroendocrine tumors. Medical therapy of neuroendocrine tumors is dependent on histological differentiation and tumor localization. Randomized trials have demonstrated the efficacy of somatostatin analogues, not only for symptom control but also for slowing down of tumor growth. The mTOR inhibitor everolimus inhibits the growth of neuroendocrine tumors in the lung, pancreas, and gastrointestinal tract compared to placebo. For the multikinase inhibitor sunitinib, which inhibits tumor-induced angiogenesis, efficacy has so far only been demonstrated for neuroendocrine tumors of the pancreas. Compared to these medical therapies, radionuclide therapy is much more effective in causing tumor shrinkage and results in a longer progression-free survival than treatment with somatostatin analogues. This has recently been confirmed by a randomized trial that has led to the approval of 177Lu-DOTA-TATE in Europe and the USA randomized study comparing 177Lu-DOTA-TOC with everolimus is currently recruiting patients. Whether the effectiveness of radionuclide therapy can be increased further by somatostatin receptor antagonists is also being investigated in prospective studies. The importance of neuroendocrine tumors for nuclear medicine is therefore likely to further increase.

Schlüsselwörter

Neuroendokrine Tumore - Somatostatinrezeptoren - PET/CT - PRRT - Theranostik

Keywords

Neuroendocrine tumors - Somatostatin receptors - PET/CT - PRRT - Theranostik
 

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