Peptide Receptor Radionuclide Therapy (PRRT) uses a radiolabelled somatostatin analog that binds to receptors on tumour cells, combined with radioactive compounds, including 111Indium, 68Galiium, 90Yttrium, 177Lutetium, to deliver the killing effect of the radioactivity directly to the cell, avoiding destruction of healthy cells often found with external beam radiation.
PRRT is not yet approved for sale in Canada, but was approved in the US by the FDA in 2017.
PRRT is not considered as a first line therapy but it is generally used after surgery for ablative techniques, radiation therapy, liver directed therapies, chemotherapy, somatostatin analog therapies, and biologically targeted therapies.
Gallium68 PET scan relies on the over-expression of somatostatin receptors to visualize NET tumours.
68Ga advantages over Octreoscan include higher resolution images, detection of smaller lesions, better guidance to treatment and dosing, exposure to less radiation, greater efficiency, cost effectiveness, access and patient convenience since it involves a two-three hour procedure.
NETTER-1 Study – Unmet need for long-term effective treatment of inoperable, gastro-entero-pancreatic neuroendocrine tumours (GEPNET).
This first Phase III trial compares 177Lu-DOTATATE with Octreotide (Sandostatin® LAR Depot) in patients with inoperable, progressive, somatostatin receptor positive midgut carcinoid tumours. 230 patients are divided into two groups of 115 each. The primary objective is to compare Progression Free Survival (PFS) between the groups. Secondary objectives are to compare Objective Response Rate, Overall Survival (OS), Time to Tumour Progression between groups, and to assess safety, tolerability and quality of life. 35 European and 15 U.S. sites are involved.
See trial details at: NETTER-1 STUDY
UPDATE ON PRRT Clinical Trials
London Health Science Centre, Edmonton, Alberta, and the Centre Hospitalier Universitaire de Quebec, Quebec City provide PRRT to eligible patients on a limited basis. Unfortunately, this does not make this therapy widely available to all who need it.
An exciting new development is the consortium of four Ontario hospitals: London Health Science Centre, University Health Network/ Princess Margaret Cancer Hospital in Toronto, Hamilton Health Sciences Centre and Sunnybrook Health Sciences Centre/ Odette Cancer Centre. The consortium has developed a protocol for a PRRT/Gallium 68 clinical trial with strong support from Cancer Care Ontario. Once approval from is received, these centres will begin enrolling.
CNETS Canada is actively involved in supporting this trial. Three NET cancer community members are on the Cancer Care Ontario trial Steering Committee. Congratulations to everyone involved in this important endeavour.
Physicians in Vancouver, Calgary, Quebec City and Ontario doctors are discussing how to make treatment more available nationally. CNETS Canada will follow these developments closely and keep you posted through the website, Facebook, our Patient Coordinator and Support Group Leaders.