Yamaguchi Naoyuki, Wei Jing-Jing, Isomoto Hajime
Department of Endoscopy, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
Department of Endoscopy, the First Affiliated Hospital of Fujian Medical University, Cha Zhong Road No.20, Tai Jiang District, Fuzhou, 350004, Fujian, China.
J Gastroenterol. 2025 Apr 12. doi: 10.1007/s00535-025-02241-z.
Effective therapeutic strategies for advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) remain challenging, including a lack of response to therapy and post-treatment relapse. The rapid development of targeted radionuclide therapy (TRT) offers promising data for patients with somatostatin receptor (SSTR)-expressing tumors. This approach exhibits more advantages than somatostatin analog (SSA) therapy, which is primarily effective for well-differentiated and slow-growing GEP-NENs. Fortunately, some clinical studies on peptide receptor radionuclide therapy (PRRT) labeled with α-emitting radionuclides for GEP-NENs patients showed effective results for those with more advanced GEP-NENs, or those with malignant metastasis. For the improvement of clinical efficacy and the decline in the incidence of treatment-related relapse, recent progress in developing novel techniques and effective disease management strategies for optimal targeting has led to the emergence of targeted alpha therapy (TAT) in GEP-NENs patients. For instance, labeled technology and combination therapy could contribute to significantly improved long-term outcomes. However, the exact dosimetry for precision oncology, the shortage of radionuclides, and the stability of disease control are still under careful consideration. More high-quality, large-scale prospective studies are essential for obtaining valuable evidence on challenging problems and for further exploration.
晚期胃肠胰神经内分泌肿瘤（GEP-NENs）的有效治疗策略仍然具有挑战性，包括对治疗缺乏反应和治疗后复发。靶向放射性核素治疗（TRT）的迅速发展为表达生长抑素受体（SSTR）的肿瘤患者提供了有前景的数据。这种方法比生长抑素类似物（SSA）治疗具有更多优势，后者主要对分化良好且生长缓慢的GEP-NENs有效。幸运的是，一些针对GEP-NENs患者使用发射α粒子的放射性核素标记的肽受体放射性核素治疗（PRRT）的临床研究表明，对于更晚期的GEP-NENs患者或有恶性转移的患者，该治疗取得了有效结果。为了提高临床疗效并降低治疗相关复发的发生率，在开发新技术和有效的疾病管理策略以实现最佳靶向方面的最新进展导致了GEP-NENs患者中靶向α治疗（TAT）的出现。例如，标记技术和联合治疗有助于显著改善长期疗效。然而，精确肿瘤学的确切剂量测定、放射性核素的短缺以及疾病控制的稳定性仍在仔细考虑之中。更多高质量、大规模的前瞻性研究对于获取有关具有挑战性问题的有价值证据以及进一步探索至关重要。
