肽受体放射性核素治疗在胃肠胰神经内分泌肿瘤治疗中的研究进展

晚期胃肠胰神经内分泌肿瘤(gastroenteropancreatic neuroendocrine neoplasm,GEP-NEN)的肽受体放射性核素治疗(peptide receptor radionuclide therapy,PRRT)研究逐渐在国内外开展。其基本原理是放射性核素标记的生长抑素类似物与神经内分泌肿瘤细胞表面过表达的生长抑素受体结合。对不可手术切除或转移性的晚期GEP-NEN来讲,肽受体放射性核素治疗在一些临床研究中表现出比传统的生长抑素类似物治疗、靶向治疗、系统化疗等方法更好的疗效,如药物Lutetium Lu ¹⁷⁷Dotatate(¹⁷⁷Lu-dotatate)已被欧美相关机构批准。安全性方面以放射性药物为主的肽受体放射性核素治疗存在骨髓毒性和肾毒性等不良反应,但相关研究表明,其安全性在一定范围内可控。本文结合国内外相关临床研究,对PRRT的原理、临床应用、未来展望进行综述。

Research progress on receptor radionuclide therapy for gastroenteropancreatic neuroendocrine neoplasm

Research on peptide receptor radionuclide therapy (PRRT) for advanced gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) is gradually advancing locally and abroad. The basic principle of PRRT for treating GEP-NEN is that radioactive nuclide-labeled somatostatin analogues can combine with somatostatin receptors (SSTRs) overexpressed on the neuroendocrine tumor cell surface so that the radioactive drug can be incorporated into the tumor cells. For inoperable or metastatic GEP-NEN, PRRT has shown better efficacy than traditional somatostatin analogue therapy, targeted therapy, and systematic chemotherapy in some clinical studies and it can prolong survival time. In particular, 177Lu-dotatate has been approved as a PRRT drug by European and American authorities. In terms of safety, as a radionuclide therapy, PRRT can cause adverse reactions such as bone marrow toxicity and nephrotoxicity. However, some studies have shown that it can be safely applied within a specific dose range.