PRRT: patient selection
Presented by Prof Dr Christophe Deroose (University Hospitals Leuven)
Prof Christophe Deroose, a prominent nuclear medicine physician and physician-scientist at UZ Leuven, provides insights from the ENETS session on patient selection for peptide-receptor radionuclide therapy (PRRT), a potent treatment for neuroendocrine tumors. PRRT has shown remarkable efficacy in achieving disease control and tumour reduction, with response probabilities ranging from 20 to 50%.
The session deliberated on criteria for patient eligibility and highlighted cases where PRRT may not be suitable, particularly in patients with reduced clinical status or kidney function. Factors such as heterogeneity in somatostatin receptor expression and mismatched lesions were emphasized as parameters for deselecting patients.
A notable aspect of the session was the presentation of cases for audience evaluation, aiming to determine optimal patient selection criteria based on response outcomes. Discussion ensued regarding the definition of response, whether radiological or clinical improvement, illustrating the complexity of patient selection.
Prof Deroose advocates for careful consideration of patients with challenging clinical presentations, such as those with vipoma-induced diarrhoea, where PRRT may offer rapid relief. He underscores the expanding indications for PRRT, including data from the NETTER2 trial suggesting efficacy in higher grade tumors and potential first-line use.
Exciting developments in PRRT include the exploration of new radiopharmaceuticals, such as antagonists with potentially enhanced binding profiles, promising increased potency. However, the most anticipated breakthrough is Alpha PRRT, utilizing different radionuclides, notably alpha emitters with much shorter path lengths and higher DNA damage potential. Preclinical and ongoing clinical trials have demonstrated significantly improved objective responses with Alpha PRRT compared to traditional PRRT with Lutetium. Phase 3 trials are underway, raising anticipation for Alpha PRRT to emerge as a beneficial therapy for patients.
