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Theranostics in Neuroendocrine Tumors

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Molecular Imaging and Targeted Therapy

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Abstract

Neuroendocrine neoplasms (NENs) are a heterogeneous group of epithelial neoplastic proliferations ranging from indolent well differentiated neuroendocrine tumors (NETs) to very aggressive poorly differentiated neuroendocrine carcinomas (NECs). The most characteristic feature of NENs is the homogeneous overexpression of peptide hormone receptors (such as somatostatin receptor, SSTR) on the tumor cell surface. The radio-theranostic concept of using a molecular marker (the targeting vehicle) for both molecular imaging and targeted radionuclide therapy has shown great promise of personalized medicine of patients with NETs. Radiolabeled SSTR agonists (111In-DTPA-octreotide, 68Ga-Dotatate, 68Ga-Dotatoc, 64Cu-Dotatate, 177Lu-Dotatate, and 177Lu-Dotatoc) are in routine clinical use for MI and TRT in patients with SSTR-2 positive NETs. Recent data indicates that radiolabeled SSTR antagonists (such as 68Ga/177Lu-NODAGA-JR11) may provide a better option for MI and therapy. Norepinephrine analog, 131I-MIBG (Azedra) is an ideal theranostic agent in patients with insufficient expression of SSTRs (such as neuroblastoma, pheochromocytoma, and paraganglioma). Several new radiotracers targeting glucagon-like peptide-1 (GLP-1) receptor, chemokine receptor-4 (CXCR4), and cholecystokinin-2 (CCK2) receptors are under active clinical investigation. This chapter provides a broad overview of the current approaches and future challenges of diagnostic and therapeutic evaluations in NENs. Theranostics in NETs serves as a model for developing targeted probes for several other cancers.

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  1. Emeritus of Radiochemistry and Radiopharmacy in Radiology, Weill Cornell Medicine, Cornell University, New York, NY, USA

    Shankar Vallabhajosula

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Vallabhajosula, S. (2023). Theranostics in Neuroendocrine Tumors. In: Molecular Imaging and Targeted Therapy. Springer, Cham. https://doi.org/10.1007/978-3-031-23205-3_21

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