The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours

John J. Zaknun, L. Bodei, J. Mueller-Brand, M. E. Pavel, R. P. Baum, D. Hörsch, M. S. O'Dorisio, T. M. O'Dorisiol, J. R. Howe, M. Cremonesi, D. J. Kwekkeboom

Research output: Contribution to journalArticle

293 Citations (Scopus)

Abstract

Peptide receptor radionuclide therapy (PRRNT) is a molecularly targeted radiation therapy involving the systemic administration of a radiolabelled peptide designed to target with high affinity and specificity receptors overexpressed on tumours. PRRNT employing the radiotagged somatostatin receptor agonists 90Y-DOTATOC ([90Y-DOTA0,Tyr 3]-octreotide) or 177Lu-DOTATATE ([177Lu- DOTA0,Tyr3,Thr8]-octreotide or [ 177Lu-DOTA0,Tyr3]-octreotate) have been successfully used for the past 15 years to target metastatic or inoperable neuroendocrine tumours expressing the somatostatin receptor subtype 2. Accumulated evidence from clinical experience indicates that these tumours can be subjected to a high absorbed dose which leads to partial or complete objective responses in up to 30 % of treated patients. Survival analyses indicate that patients presenting with high tumour receptor expression at study entry and receiving 177Lu-DOTATATE or 90Y-DOTATOC treatment show significantly higher objective responses, leading to longer survival and improved quality of life. Side effects of PRRNT are typically seen in the kidneys and bone marrow. These, however, are usually mild provided adequate protective measures are undertaken. Despite the large body of evidence regarding efficacy and clinical safety, PRRNT is still considered an investigational treatment and its implementation must comply with national legislation, and ethical guidelines concerning human therapeutic investigations. This guidance was formulated based on recent literature and leading experts' opinions. It covers the rationale, indications and contraindications for PRRNT, assessment of treatment response and patient follow-up. This document is aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRNT and to deliver the treatment in a safe and effective manner. This document is largely based on the book published through a joint international effort under the auspices of the Nuclear Medicine Section of the International Atomic Energy Agency.

Original languageEnglish
Pages (from-to)800-816
Number of pages17
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume40
Issue number5
DOIs
Publication statusPublished - 2013

Fingerprint

Peptide Receptors
Neuroendocrine Tumors
Radioisotopes
Joints
Therapeutics
Nuclear Medicine
Nuclear Energy
Neoplasms
Somatostatin Receptors
Investigational Therapies
Octreotide
Expert Testimony
Survival Analysis
Legislation
Radiotherapy
Bone Marrow
Quality of Life
Guidelines
Kidney
Safety

Keywords

  • Guideline/s
  • Neuroendocrine tumours
  • Peptide receptor radionuclide therapy
  • PRRNT
  • Renal protection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. / Zaknun, John J.; Bodei, L.; Mueller-Brand, J.; Pavel, M. E.; Baum, R. P.; Hörsch, D.; O'Dorisio, M. S.; O'Dorisiol, T. M.; Howe, J. R.; Cremonesi, M.; Kwekkeboom, D. J.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 40, No. 5, 2013, p. 800-816.

Research output: Contribution to journalArticle

Zaknun, JJ, Bodei, L, Mueller-Brand, J, Pavel, ME, Baum, RP, Hörsch, D, O'Dorisio, MS, O'Dorisiol, TM, Howe, JR, Cremonesi, M & Kwekkeboom, DJ 2013, 'The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours', European Journal of Nuclear Medicine and Molecular Imaging, vol. 40, no. 5, pp. 800-816. https://doi.org/10.1007/s00259-012-2330-6
Zaknun, John J. ; Bodei, L. ; Mueller-Brand, J. ; Pavel, M. E. ; Baum, R. P. ; Hörsch, D. ; O'Dorisio, M. S. ; O'Dorisiol, T. M. ; Howe, J. R. ; Cremonesi, M. ; Kwekkeboom, D. J. / The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. In: European Journal of Nuclear Medicine and Molecular Imaging. 2013 ; Vol. 40, No. 5. pp. 800-816.
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