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).90Y-DOTATOC and177Lu-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 of90Y-DOTATOC. Options to improve PRRT may include combinations of radioactive labelled somatostatin analogues and the use of radiosensitising drugs combined with PRRT. Other therapeutic applications of PRRT may include intra-arterial administration, neo-adjuvant 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.

Lutetium, Neuroendocrine tumours, PRRT, Peptide receptor radionuclide therapy, Somatostatin analogues, Yttrium,
Best Practice and Research in Clinical Gastroenterology
Erasmus MC: University Medical Center Rotterdam

Bergsma, H, van Vliet, E.I, Teunissen, J.J.M, Kam, B.L, de Herder, W.W, Peeters, R.P, … Kwekkeboom, D. (2012). Peptide receptor radionuclide therapy (PRRT) for GEP-NETs. Best Practice and Research in Clinical Gastroenterology, 26(6), 867–881. doi:10.1016/j.bpg.2013.01.004