ESMO E-Learning: Current and Future Perspectives of Theranostics in the Field of NETs

In this E-Learning module, the authors elaborate essentials in neuroendocrine tumours (NET’s). They provide basic principles of the theranostics use in NETs, describe the current applications of theranostics in NETs, provide an overview of modern pivotal phase III clinical trials in patients with advanced NETs, algorithms for the management based on the clinical practice guidelines and elaborate theranostics perspective in NETs.  

NETs are rare neoplasms with increasing incidence. Most NETs arise from the digestive and pulmonary systems. Most NETs are associated with metastases. Patients with metastatic NETs often have prolonged course of disease with 5-year overall survival rate of 50-70%. The main prognostic factors of NETs are the primary tumour site, stage, grade (Ki-67), tumour growth rate and tumour burden.

Therapeutic options for non-resectable NETs include long-acting somatostatin analogues (lanreotide, octreotide), systemic chemotherapy (alkylating agents, platinum-based), transarterial (chemo)-embolisation, everolimus, sunitinib, peptide receptor-radionuclide therapy (177Lu-DOTATATE). Therapeutic decision making mostly relies on prognostic factors. The authors underline that these treatments have not or poorly been compared between each other, factors predictive of their efficacy have yet to be determined and emphasise on the importance of multidisciplinary expert discussions.

In this interesting module, the authors provide the theranostics definition as the use of a diagnostic test, identifying a marker, to guide the patient's therapy according to the marker status. Mechanisms of action of radiopharmaceuticals are elaborated and current applications well explained, clinical benefits and toxicities described, the results from the clinical studies detailed, and future perspectives elaborated as emerging pharmaceuticals should be explored.