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Nuklearmedizinische Therapie endokriner Tumoren

Radionuclide therapy of endocrine-related cancer

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Zusammenfassung

Dieser Artikel gibt einen Überblick über die etablierten sowie weitere vielversprechende, aktuell im Rahmen von Studien eingesetzte nuklearmedizinische Therapiemöglichkeiten diverser endokrinologischer Neoplasien. Die Radiojodtherapie ist unverändert die Therapie der Wahl beim differenzierten, jodspeichernden Schilddrüsenkarzinom. Im metastasierten Stadium sind in ca. 50 % der Fälle noch (sub)totale Remissionen möglich, die 15-Jahres-Überlebensrate liegt für diese Patienten um die 90 %. Auch die Metaiodbenzylguanidin(MIBG)-Therapie hat in Europa Marktzulassung und kann nach aktueller Literatur bei der Behandlung inoperabler Neuroblastome und maligner Phäochromozytome bzw. Paragangliome bei gut 30 % der Patienten eine signifikante Tumorverkleinerung, bei knapp 80 % ein sekretorisches Ansprechen bzw. eine Symptomverbesserung bewirken. Nach vielversprechenden Phase-2-Daten zur Therapie neuroendokriner Tumoren mit radioaktiven Somatostatinanaloga wie DOTATATE oder DOTATOC, bei denen sich jeweils 24 bis 36 Monate progressionsfreies Überleben unter Therapie gezeigt haben, rekrutiert aktuell eine erste Phase-3-Zulassungsstudie für intestinale Karzinoide. Mit radioaktiven Konjugaten auf Basis der Peptidhormone GLP1 und Minigastrin sind zielgerichtete Tracer für Insulinome und medulläre Schilddrüsenkarzinome in der frühen klinischen Erprobung. Vor der zielgerichteten Therapie mit dichtionisierend strahlenden Radionukliden erfolgt in der Regel eine Bildgebung mit Gammastrahlen emittierenden, diagnostischen Analogsubstanzen, um somit eine auf dem Tumorphänotyp basierende Patientenstratifizierung zu ermöglichen.

Abstract

This article gives an overview of the established radionuclide therapies for endocrine-related cancer that already have market authorization or are currently under evaluation in clinical trials. Radioiodine therapy is still the gold standard for differentiated iodine-avid thyroid cancer. In patients with bone and lung metastases (near) total remission is seen in approximately 50 % and the 15-year survival rate for these patients is approximately 90 %. In contrast to the USA, meta-iodobenzylguanidine (MIBG) therapy has market approval in Europe. According to the current literature, in the setting of advanced stage neuroblastoma and malignant pheochromocytoma or paraganglioma, radiological remission can be achieved in > 30 % and symptom control in almost 80 % of the treated patients. Somatostatin receptor targeted radionuclide therapies (e.g. with DOTATATE or DOTATOC) demonstrated promising results in phase 2 trials, reporting progression-free survival in the range of 24–36 months. A first phase 3 pivotal trial for intestinal carcinoids is currently recruiting and another trial for pancreatic neuroendocrine tumors is planned. Radiopharmaceuticals based on glucagon-like peptide 1 (GLP1) or minigastrins are in the early evaluation stage for application in the treatment of insulinomas and medullary thyroid cancer. In general, radiopharmaceutical therapy belongs to the group of so-called theranostics which means that therapy is tailored for individual patients based on molecular imaging diagnostics to stratify target positive or target negative tumor phenotypes.

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Danksagung

Wir danken Herrn Prof. Mäcke für die freundliche Überlassung eines Bildbeitrags zu Diagnostik des MTC mit radioaktiven Minigastrin-Analoga.

Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Kratochwil und F.L. Giesel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung Nuklearmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    C. Kratochwil & F.L. Giesel

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  1. C. Kratochwil
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  2. F.L. Giesel
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Correspondence to C. Kratochwil.

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Kratochwil, C., Giesel, F. Nuklearmedizinische Therapie endokriner Tumoren. Radiologe 54, 1007–1015 (2014). https://doi.org/10.1007/s00117-014-2691-x

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