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Yttrium-labelled peptides for therapy of NET

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Abstract

Peptide receptor radionuclide therapy (PRRT) consists in the systemic administration of a synthetic peptide, labelled with a suitable beta-emitting radionuclide, able to irradiate tumours and their metastases via the internalization through a specific receptor, overexpressed on the cell membrane. After 15 years of experience, we can state that PRRT with 90Y-labelled peptides is generally well tolerated. Acute side effects are usually mild, some of which are related to the co-administration of amino acids, such as nausea. Others are related to the radiopeptide, such as fatigue or the exacerbation of an endocrine syndrome, which rarely occurs in functioning tumours. Chronic and permanent effects on target organs, particularly the kidneys and the bone marrow, are generally mild if the necessary precautions are taken. Currently, the potential risk to kidney and red marrow limits the amount of radioactivity that may be administered. However, when tumour masses are irradiated with adequate doses, volume reduction may be observed. 90Y-octreotide has been the most widely used radiopeptide in the first 8–10 years of experience. Unfortunately, all of the published results derive from different and inhomogeneous phase I/II studies. Hence, a direct comparison is virtually impossible to date. Nevertheless, even with these limitations, objective responses are registered in 10–34% of patients. The optimal timing of 90Y-DOTATOC in the management of somatostatin receptor (SSTR)-positive tumours and the way in which it should be integrated with other treatments have yet to be defined, and prospective phase II/III trials comparing the efficacy and toxicity of different schemes of 90Y-DOTATOC administration are still warranted.

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Conflicts of interest

LB and GP declare one-occasion consultancy with Advanced Accelerator Applications during the preliminary phase of product development of 177Lu-DOTATATE in Italy. All other authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Division of Nuclear Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    Lisa Bodei, Chiara M. Grana, Marco Chinol, Silvia M. Baio & Giovanni Paganelli

  2. Division of Medical Physics, European Institute of Oncology, Milan, Italy

    Marta Cremonesi

  3. Radiometabolic Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (FC), Italy

    Stefano Severi

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  1. Lisa Bodei
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  2. Marta Cremonesi
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Correspondence to Giovanni Paganelli.

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Bodei, L., Cremonesi, M., Grana, C.M. et al. Yttrium-labelled peptides for therapy of NET. Eur J Nucl Med Mol Imaging 39 (Suppl 1), 93–102 (2012). https://doi.org/10.1007/s00259-011-2002-y

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