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DOI: 10.1055/a-1826-3423
Theranostics bei gut bis mäßig differenzierten GEP-NEN
Theranostics for Well and Moderately Differentiated GEP-NENZusammenfassung
Neuroendokrine Neoplasien (NEN) sind seltene, heterogene und typischerweise langsam wachsende Tumoren. Die häufigsten Lokalisationen finden sich im gastro-entero-pankreatischen System (GEP-NEN). NENs werden nach proliferativer Aktivität (Ki-67-Index) eingeteilt (G1–3). Gut differenzierte Tumoren exprimieren dabei typischerweise Somatostatinrezeptoren (SSTR), die als Zielstruktur in der nuklearmedizinischen Theranostik dienen. Bei diesem Prinzip kann nach einer diagnostischen molekularen Bildgebung, meist mittels Positronenemissionstomografie/Computertomografie (PET/CT), eine individuell zugeschnittene Peptidradiorezeptortherapie (PRRT) mit einem β-Strahler-markierten Radiopharmakon erfolgen. In Metaanalysen zeigte die Diagnostik mittels SSTR-gerichteter PET/CT eine Sensitivität von 93% und eine Spezifität von 96%. Die SSTR-gerichtete Diagnostik kann auch zur radioaktiven Markierung von Tumoren verwendet werden, um eine zielgerichtete Chirurgie zu ermöglichen. Die Indikation zur Einleitung einer PRRT soll stets in einer interdisziplinären Tumorkonferenz getroffen werden. Ein Tumorprogress unter der vorangegangenen Therapie sollte dokumentiert sein. Die Therapie wird intravenös und insgesamt 4-mal in 8-wöchigem Abstand in spezialisierten nuklearmedizinischen Zentren verabreicht. Die Wirksamkeit der PRRT wurde in der NETTER-1-Studie prospektiv untersucht und konnte eine signifikante Verbesserung des progressionsfreien Überlebens (primärer Endpunkt) zeigen. Ausgehend von diesen Studienergebnissen steht mit Lutathera (177Lu-DOTATATE) inzwischen ein in Deutschland zugelassenes Radiopharmazeutikum zu Behandlung von nicht resektablen oder metastasierten bzw. progredienten, gut differenzierten (G1 und G2), SSTR-positiven GEP-NEN zur Verfügung.
Abstract
Neuroendocrine neoplasms (NEN) are rare, heterogeneous, and typically slowly growing tumours. The most common location is the gastro-entero-pancreatic system (GEP-NEN). NENs are classified according to their proliferative activity (Ki-67 index, G1–3). In this context, well-differentiated tumours typically express somatostatin receptors (SSTR), thus serving as targets for nuclear medicine theranostics. In this approach, diagnostic molecular imaging, usually by positron emission tomography/computed tomography (PET/CT), can be followed by individually tailored peptide radioreceptor therapy (PRRT) with a β-emitter labeled radiopharmaceutical. In meta-analyses, diagnostics using SSTR-directed PET/CT showed a sensitivity of 93% and a specificity of 96%. SSTR-directed diagnostics can also be used to trace tumours in-vivo, enabling radioguided surgery. The decision to initiate PRRT should always be made in an interdisciplinary tumour conference and tumour progression during previous therapy should be documented. This treatment is administered intravenously for 4 times at 8-week intervals in specialised nuclear medicine centres. PRRT efficacy was prospectively evaluated in the NETTER-1 study and demonstrated a significant improvement in progression-free survival (primary endpoint). Based on these results, Lutathera (177Lu-DOTATATE) is now available as a radiopharmaceutical approved in Germany for the treatment of non-resectable or metastatic or progressive, well-differentiated (G1 and G2), SSTR-positive GEP-NEN.
Schlüsselwörter
neuroendokrine Tumoren - Peptid Radiorezeptor Therapie - Somatostatinrezeptoren - PET/CT - NuklearmedizinKeywords
neuroendocrine tumors - peptide radioreceptor therapy - somatostatin receptors - PET/CT - nuclear medicinePublication History
Received: 07 February 2022
Accepted after revision: 11 April 2022
Article published online:
15 June 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
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