La radiothérapie interne vectorisée par les analogues de la somatostatine,en pratique,en 2019

Somatostatin receptors are overexpressed in differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NET). Radiolabeled somatostatin analogs have been used for a few decades for imaging and more recently for peptide receptor radionuclide therapy (PRRT) in a theranostic approach. Medical access to PRRT has long been limited to a few European specialized medical centers despite promising results in large cohorts of patients. NETTER-1, a phase 3 randomized trial, has demonstrated a drastic improvement of midgut NET patients progression-free survival in PRRT arm as compared to somatostatin analogs, leading to marketing authorizations in USA and Europe. PRRT clinical availability is growing in France, with around 20 medical centers offering this innovative treatment for GEP-NET patients care in 2019. PPRT success-story should lead to improvements of radionuclide therapy developments, which will reshape our medical specialty to a more “clinically” practice. This review aims to detail PRRT in clinical practice in France in 2019, with emphasize on treatment indications, planning and practical aspects. Radioprotection aspects and future optimization perspectives will also be discussed.     

Radionuclide therapy targeting PSMA for the treatment of metastatic prostate cancer: Current point of view and ways of improvement

Metastatic castration-resistant prostate cancer (mCRPC) still represents a challenge and an unmet clinical need. RadioLigand therapy targeting PSMA (PRLT) has been used for several years with success and low toxicity. The first radionuclide used were radiolabeled antibody with limited dose due to hematologic toxicity. Rapidly, small molecules targeting PSMA were developed and used with lower toxicity, mostly related to mild transient xerostomia and nausea due to physiological PSMA expression in the salivary glands and proximal bowel. Briefly, 2/3 of the patients may first respond to treatments followed by disease recurrence responding to further cycles for half of them. Therefore, there is a need to improve again the PRLT efficacy and the ways of improvement will be discussed in this review.