Peptidradiorezeptor-Therapie (PRRT)

Zusammenfassung

Neuroendokrine Neoplasien (NEN) stellen ein komplexes, heterogenes Krankheitsbild dar, wobei der Primärtumorlokation meist im Gastrointestinaltrakt lokalisiert ist. Als „Orphan Disease“ sind NEN zwar selten, werden aber primär durch eine verbesserte bildgebende Diagnostik in den letzten Jahren verstärkt diagnostiziert. Hierbei spielt die Somatostatinrezeptor (SSTR)-gerichtete molekulare Bildgebung eine große Rolle, insbesondere die Einzelphotonen-Emissions-Computertomografie (SPECT) sowie die Positronen-Emissions-Tomografie (PET). Neben einer exakten Ausbreitungsdiagnostik generiert die SSTR-gerichtete Bildgebung auch eine Therapierationale für eine Peptidradiorezeptortherapie (PRRT) in einem sog. „theranostischen“ Ansatz. Hierbei wird ein β-Strahler mit dem identischen Peptid des diagnostischen SPECT-/PET-Gegenstücks gekoppelt, um somit eine gezielte, SSTR-gerichtete Bestrahlung von NEN und metastatischer Läsionen zu ermöglichen. Das daraus resultierende „heiße“ Somatostatinanalogon kann als hocheffektives Radiotherapeutikum mit akzeptablem Nebenwirkungsprofil eingesetzt werden, was bereits in einer randomisierten, prospektiven, multizentrischen Studie belegt wurde. Die PRRT erfolgt in Deutschland stationär auf einer nuklearmedizinischen Isotopenstation, wobei Indikation, Durchführung und Nachsorge dieser zielgerichteten Therapie in einem interdisziplinären Ansatz in enger Absprache mit Kolleg*innen der Inneren Medizin, der Medizinphysik und Nuklearmedizin erfolgen sollte. Mit Lutathera (¹⁷⁷Lu-Oxodotreotid) steht seit Kurzem ein in Deutschland zugelassenes Arzneimittel zur SSTR-gerichteten Therapie zur Verfügung, womit die PRRT verstärkt Anwendung finden dürfte.

Abstract

The umbrella term neuroendocrine neoplasia (NEN) encompasses a heterogenous and complex spectrum of various tumor entities, with the vast majority being located in the gastrointestinal tract. As an “orphan malignancy”, recent years have witnessed an increased incidence of NEN, mainly due to an improved diagnostic work-up. In this regard, somatostatin receptor (SSTR) directed molecular imaging is increasingly utilized, in particular single photon emission computed tomography and positron emission tomography. These molecular imaging techniques provide an exact read-out of the entire tumor burden, but also lay the foundations for a theranostic approach (peptide receptor radionuclide therapy [PRRT]). By using the β-emitting equivalent of the diagnostic image agent, such highly effective, therapeutic radiolabeled compounds can be safely administered, and their therapeutic efficacy has already been demonstrated in a large, prospective multicenter trial. In Germany, PRRT is routinely conducted at a nuclear medicine ward. Nonetheless, PRRT is a multidisciplinary team effort and should be performed in close collaboration with physicists, referring treating internal medicine physicians and nuclear medicine experts. Moreover, the SSTR-targeted therapeutic compound Lutathera (¹⁷⁷Lu-labeled oxodotreotide) has been recently approved in Germany, which will make PRRT more widely available in the future.

Schlüsselwörter

Peptidradiorezeptortherapie - PRRT - Neuroendokrine Tumore - NEN - NET - Theranostics - SSTR - Somatostatinrezeptor

Keywords

peptide receptor radionuclide therapy - PRRT - Neuroendocrine Tumors - NEN - NET - theranostics - SSTR - somatostatin receptor

Publication History

Article published online:
29 November 2021

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