Peptide receptor radionuclide therapy for neuroendocrine tumours: standardized and randomized, or personalized?

Excerpt

Neuroendocrine tumours are a heterogeneous group of tumours arising from a variety of specific chemical signalling cells in a range of organs. Superimposed on this intrinsic diversity of origin, they display a spectrum of biological behaviour from indolent well-differentiated tumours that may produce a variety of hormones, to aggressive poorly-differentiated phenotypes that have rapid proliferation [1]. However, because of their collective rarity, they tend to get grouped into a single disease category for purposes of imaging and therapeutic trials. Peptide receptor radionuclide therapy (PRRT) is an evolving therapy but its utility is questioned by some because of the absence of prospective randomized controlled trials (RCTs). It sits amongst a growing number of therapeutic options, including pharmacological, hormonal [2] and liver-directed therapies, and surgical approaches. Pharmacological options include the mTOR inhibitor everolimus [3], the tyrosine kinase inhibitor sunitinib [4], and a variety of combination chemotherapy regimens, with promising results obtained with the combination of capecitabine and temozolomide in pancreatic NET in particular [5]. …