Raymond Lauren M, Korzun Tetiana, Kardosh Adel, Kolbeck Kenneth J, Pommier Rodney, Mittra Erik S
School of Medicine, Oregon Health & Science University, Portland, Oregon, USA,
School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Neuroendocrinology. 2021;111(11):1086-1098. doi: 10.1159/000516015. Epub 2021 Mar 19.
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are the most common form of neuroendocrine neoplasia, but there is no current consensus for the sequencing of approved therapies, particularly with respect to peptide receptor radionuclide therapy (PRRT). This comprehensive review evaluates the data supporting approved therapies for GEP-NETs and recommendations for therapeutic sequencing with a focus on how PRRT currently fits within sequencing algorithms. The current recommendations for PRRT sequencing restrict its use to metastatic, inoperable, progressive midgut NETs; however, this may change with emerging data to suggest that PRRT might be beneficial as neoadjuvant therapy for inoperable tumors, is more tolerable than other treatment modalities following first-line standard dose somatostatin analogs, and can be used as salvage therapy after disease relapse following prior successful cycles of PRRT. PRRT has also been shown to reduce tumor burden, improve quality of life, and prolong the time to disease progression in a broad spectrum of patients with GEP-NETs. As the various potential benefits of PRRT in GEP-NET therapy continues to expand, it is necessary to review and critically evaluate our treatment algorithms for GEP-NETs.
胃肠胰神经内分泌肿瘤（GEP-NETs）是神经内分泌肿瘤最常见的形式，但目前对于已获批疗法的排序尚无共识，尤其是在肽受体放射性核素治疗（PRRT）方面。这篇综述全面评估了支持GEP-NETs获批疗法的数据以及治疗排序的建议，重点关注PRRT目前在排序算法中的适用情况。目前PRRT排序的建议将其使用限制于转移性、无法手术切除、进展性的中肠神经内分泌肿瘤；然而，随着新数据的出现，这种情况可能会改变，新数据表明PRRT作为无法手术切除肿瘤的新辅助治疗可能有益，在一线标准剂量生长抑素类似物治疗后比其他治疗方式耐受性更好，并且在先前PRRT成功治疗周期后疾病复发时可作为挽救治疗。PRRT还已被证明可减轻肿瘤负荷、改善生活质量并延长广泛GEP-NETs患者的疾病进展时间。随着PRRT在GEP-NET治疗中的各种潜在益处不断扩展，有必要对我们的GEP-NET治疗算法进行回顾和批判性评估。
