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

Eur J Nucl Med Mol Imaging (2013) 40:800816 DOI 10.1007/s00259-012-2330-6

GUIDELINES

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. Hrsch & M. S. ODorisio &

T. M. ODorisiol & J. R. Howe & M. Cremonesi &

D. J. Kwekkeboom

Published online: 7 February 2013# The Author(s) 2013. This article is published with open access at Springerlink.com

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,Tyr3]-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

L. BodeiDivision of Nuclear Medicine, European Institute of Oncology, Milan, Italy

J. J. Zaknun (*)

Nuclear Medicine Section, Division of Human Health, International Atomic Energy Agency, IAEA, Vienna, Austria e-mail: [email protected]

J. J. Zaknune-mail: [email protected]

J. J. ZaknunZentralklinik Bad Berka, Center for Molecular Radiotherapy and Molecular Imaging, ENETS Center of Excellence, Bad Berka, Germany

J. Mueller-BrandKlinik und Institut fr Nuklearmedizin, Universittsspital Basel, Basel, Switzerland

M. E. PavelCampus Virchow Klinikum, Klinik fr Gastroenterologie, Hepatologie, Endokrinologie, Diabetes und Stoffwechsel-erkrankungen, Charit Universitaetsmedizin Berlin, Berlin, Germany

R. P. Baum : D. HrschZentralklinik Bad Berka, Department of Internal Medicine, Gastroenterology and Endocrinology, ENETS Center of Excellence, Bad Berka, Germany

M. S. ODorisioRJ and LA Carver College of Medicine, Department of Pediatrics, University of Iowa, Iowa City, IA, USA

T. M. ODorisiolRJ and LA Carver College of Medicine, Department of Internal Medicine, University...