Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
Curr Treat Options Oncol. 2019 Aug 29;20(10):77. doi: 10.1007/s11864-019-0677-7.
Neuroendocrine neoplasia (NEN) represents a heterogenous group of tumours. Guidelines regarding treatment choice and sequencing remain complex given varied primary sites, hormone-secretory status, tumour grade, disease heterogeneity, and paucity of rigorous comparative trials due to rarity of this condition. However, there is increasing evidence that peptide receptor radionuclide therapy (PRRT) is an effective treatment, especially for grade 1 and 2 NEN. Primary indications for treatment include oncologic control in patients with progressive disease and symptomatic control in the context of hormone-secretory syndromes or tumour-related pain. However, strategies are needed to further optimize efficacy and outcomes, and to expand treatment indications. Important considerations could include personalized PRRT regimens based on better characterization of the disease in an individual patient. Future directions should also focus on strategies to further enhance the efficacy of PRRT including combination treatments with other systemic therapies, such as radiosensitising chemotherapy, DNA repair-modifying agents and immunotherapy. Further evolution of therapeutic radiopharmaceuticals also offers promise.
神经内分泌肿瘤（NEN）是一组异质性肿瘤。鉴于不同的原发部位、激素分泌状态、肿瘤分级、疾病异质性以及由于这种疾病罕见而缺乏严格的对照试验，治疗选择和方案的指南仍然很复杂。然而，越来越多的证据表明肽受体放射性核素治疗（PRRT）是一种有效的治疗方法，特别是对于 1 级和 2 级 NEN。治疗的主要适应证包括对进展性疾病患者进行肿瘤控制以及在激素分泌综合征或肿瘤相关疼痛的情况下进行症状控制。然而，需要制定策略来进一步优化疗效和结果，并扩大治疗适应证。重要的考虑因素可能包括基于个体患者疾病更好特征化的个性化 PRRT 方案。未来的方向还应侧重于进一步提高 PRRT 疗效的策略，包括与其他全身治疗（如放射增敏化疗、DNA 修复修饰剂和免疫疗法）联合治疗。治疗放射性药物的进一步发展也有希望。
