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European Journal of Nuclear Medicine and Molecular Imaging

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01.05.2010 | Review Article

Kidney protection during peptide receptor radionuclide therapy with somatostatin analogues

verfasst von: Edgar J. Rolleman, Marleen Melis, Roelf Valkema, Otto C. Boerman, Eric P. Krenning, Marion de Jong

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 5/2010

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Abstract

This review focuses on the present status of kidney protection during peptide receptor radionuclide therapy (PRRT) using radiolabelled somatostatin analogues. This treatment modality for somatostatin receptor-positive tumours is limited by renal reabsorption and retention of radiolabelled peptides resulting in dose-limiting high kidney radiation doses. Radiation nephropathy has been described in several patients. Studies on the mechanism and localization demonstrate that renal uptake of radiolabelled somatostatin analogues largely depends on the megalin/cubulin system in the proximal tubule cells. Thus methods are needed that interfere with this reabsorption pathway to achieve kidney protection. Such methods include coadministration of basic amino acids, the bovine gelatin-containing solution Gelofusine or albumin fragments. Amino acids are already commonly used in the clinical setting during PRRT. Other compounds that interfere with renal reabsorption capacity (maleic acid and colchicine) are not suitable for clinical use because of potential toxicity. The safe limit for the renal radiation dose during PRRT is not exactly known. Dosimetry studies applying the principle of the biological equivalent dose (correcting for the effect of dose fractionation) suggest that a dose of about 37 Gy is the threshold for development of kidney toxicity. This threshold is lower when risk factors for development of renal damage exist: age over 60 years, hypertension, diabetes mellitus and previous chemotherapy. A still experimental pathway for kidney protection is mitigation of radiation effects, possibly achievable by cotreatment with amifostine (Ethylol), a radiation protector, or with blockers of the renin-angiotensin-aldosterone system. Future perspectives on improving kidney protection during PRRT include combinations of agents to reduce renal retention of radiolabelled peptides, eventually together with mitigating medicines. Moreover, new somatostatin analogues with lower renal retention may be developed. Furthermore, knowledge on kidney protection from radiolabelled somatostatin analogues may be expanded to other peptides.

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Titel: Kidney protection during peptide receptor radionuclide therapy with somatostatin analogues
verfasst von: Edgar J. Rolleman
Marleen Melis
Roelf Valkema
Otto C. Boerman
Eric P. Krenning
Marion de Jong
Publikationsdatum: 01.05.2010
Verlag: Springer-Verlag
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 5/2010
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-009-1282-y

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Kidney protection during peptide receptor radionuclide therapy with somatostatin analogues

Abstract

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

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