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Nuclear Oncology pp 1243–1267Cite as

Neuroendocrine Tumors: Therapy with Radiolabeled Peptides

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Abstract

Treatment of neuroendocrine tumors (NETs) is typically multidisciplinary and should be individualized according to the tumor histology, lesion extent, patient performance status, and symptoms. Surgery is the only potentially curative option. NET liver metastases are typically hypervascular, and chemoembolization or bland embolization of the hepatic artery, performed mechanically by microspheres or chemically with cytotoxic agents, can lead to significant necrosis. Medical therapy is directed at the control of symptoms and/or reducing tumor growth. Strategies range from the use of bioactive agents (somatostatin analogues or interferon) to conventional chemotherapy. PRRT uses radiolabeled somatostatin analogue peptides to treat unresectable or metastasized NETs. The therapeutic strategy of PRRT has been utilized for more than two decades and is accepted as an effective therapeutic modality in the treatment of inoperable or metastatic GEP, bronchopulmonary, and other NETs. PRRT with either 90Y-DOTATOC or 177Lu-DOTATATE is generally extremely well tolerated, with modest toxicity to the target organs, such as the kidneys and bone marrow. The chapter illustrates the efficacy and safety features of these compounds.

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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-d-glucose

5-FU:

5-Fluorouracil

BED:

Bioeffective radiation dose

BP:

Bronchopulmonary

CEA:

Carcinoembryonic antigen, a tumor-associated marker

CgA:

Chromogranin A, a tumor-associated marker for neuroendocrine tumors

CI:

Confidence interval

CR:

Complete response

CT:

X-ray computed tomography

DOTA:

2-(4-Isothiocyanatobenzyl-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (macrocyclic coupling agent to label compounds of biological interest with metal radionuclides)

DOTATATE:

DOTA-Tyr3-Thr8-octreotide

DOTATOC:

DOTA-Tyr3-octreotide

FDA:

United States Food and Drug Administration

GEP:

Originated in the gastroenteropancreatic tract

GFR:

Glomerular filtration rate

Gy:

Gray unit (ionizing radiation dose in the International System of Units, corresponding to the absorption of one joule of radiation energy per kilogram of matter)

KPS:

Karnofsky performance status

LCNEC:

Large-cell neuroendocrine carcinoma

MDS:

Myelodysplastic syndrome

MEN:

Multiple endocrine neoplasia

MIRD:

Medical internal radiation dose

MR:

Mixed response

MRI:

Magnetic resonance imaging

mTOR:

Mammalian target of rapamycin

NEN:

Neuroendocrine neoplasia

NET:

Neuroendocrine tumor

NSE:

Neuron-specific enolase

OLINDA:

Organ level internal dose assessment/Exponential modeling

OS:

Overall survival

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/Computed tomography

PFS:

Progression-free survival

PR:

Partial response

PRRT:

Peptide receptor radionuclide therapy

QoL:

Quality of life

RECIST:

Response evaluation criteria in solid tumors

SCLC:

Small-cell lung cancer

SD:

Stabilization of disease

SPECT:

Single-photon computed tomography

SPECT/CT:

Single-photon computed tomography/Computed tomography

SSA:

Somatostatin analog

SSTR:

Somatostatin receptor

SUV:

Standardized uptake value

SUVmax :

Standardized uptake value at point of maximum

SWOG:

Southwest Oncology Group, an organization supported by the National Cancer Institute of the United States to conduct clinical trials in adult cancers

TTP:

Time to progression

VEGF:

Vascular endothelial growth factor

WHO:

World Health Organization

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Authors and Affiliations

  1. Division of Nuclear Medicine, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy

    Laura Gilardi & Chiara M. Grana

  2. Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Lisa Bodei

  3. Wren Laboratories, Branford, CT, USA

    Mark Kidd & Irvin M. Modlin

  4. Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy

    Duccio Volterrani

  5. Nuclear Medicine and Radiometabolic Units, “Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori” (IRST) IRCCS, Meldola, Italy

    Giovanni Paganelli

  6. Department of Surgery, Yale School of Medicine, 310 Cedar St, New Haven, CT, 06510, USA

    Irvin M. Modlin

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  1. Lisa Bodei
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  2. Laura Gilardi
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  3. Duccio Volterrani
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  4. Giovanni Paganelli
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  5. Chiara M. Grana
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  6. Mark Kidd
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  7. Irvin M. Modlin
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Correspondence to Lisa Bodei .

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Editors and Affiliations

  1. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    H. William Strauss

  2. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

    Giuliano Mariani

  3. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

    Duccio Volterrani

  4. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Steven M. Larson

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Bodei, L. et al. (2017). Neuroendocrine Tumors: Therapy with Radiolabeled Peptides. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26236-9_50

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  • DOI: https://doi.org/10.1007/978-3-319-26236-9_50

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