Halfdanarson Thorvardur R, Mallak Nadine, Paulson Scott, Chandrasekharan Chandrikha, Natwa Mona, Kendi Ayse Tuba, Kennecke Hagen F
Mayo Clinic, Rochester, MN 55905, USA.
Division of Molecular Imaging and Therapy, Oregon Health and Science University, Portland, OR 97239, USA.
Cancers (Basel). 2023 Oct 2;15(19):4836. doi: 10.3390/cancers15194836.
Radioligand therapy (RLT) with [Lu]Lu-DOTA-TATE is a standard of care for adult patients with somatostatin-receptor (SSTR)-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Taking advantage of this precision nuclear medicine approach requires diligent monitoring and surveillance, from the use of diagnostic SSTR-targeted radioligand imaging for the selection of patients through treatment and assessments of response. Published evidence-based guidelines assist the multidisciplinary healthcare team by providing acceptable approaches to care; however, the sheer heterogeneity of GEP-NETs can make these frameworks difficult to apply in individual clinical circumstances. There are also contradictions in the literature regarding the utility of novel approaches in monitoring and surveilling patients with GEP-NETs receiving RLT. This article discusses the emerging evidence on imaging, clinical biochemistry, and tumor assessment criteria in the management of patients receiving RLT for GEP-NETs; additionally, it documents our own best practices. This allows us to offer practical guidance on how to effectively implement monitoring and surveillance measures to aid patient-tailored clinical decision-making.
使用[镥]镥-多胺基多羧基大环配体-生长抑素类似物（[Lu]Lu-DOTA-TATE）进行放射性配体疗法（RLT）是生长抑素受体（SSTR）阳性胃肠胰神经内分泌肿瘤（GEP-NETs）成年患者的标准治疗方法。要利用这种精准核医学方法，需要进行细致的监测，从使用诊断性SSTR靶向放射性配体成像来选择患者，贯穿整个治疗过程以及对治疗反应的评估。已发表的循证指南通过提供可接受的治疗方法来协助多学科医疗团队；然而，GEP-NETs的高度异质性使得这些框架在个体临床情况下难以应用。关于GEP-NETs患者接受RLT时新型监测方法的效用，文献中也存在矛盾之处。本文讨论了在接受GEP-NETs的RLT治疗的患者管理中，关于成像、临床生物化学和肿瘤评估标准的新证据；此外，还记录了我们自己的最佳实践。这使我们能够就如何有效实施监测措施提供实用指导，以辅助针对患者的临床决策。
