Peptide receptor radionuclide therapy, also known as PRRT, is an emerging treatment option for neuroendocrine tumours (NETs) in Italy. This novel form of targeted radiotherapy is showing promising results and is being adopted by more oncology facilities across the country.
What is PRRT?
PRRT is a type of systemic radiotherapy where small amounts of radioactive substances are attached to peptides that bind to receptors on cancer cells. The most common peptide used is Octreotide, which binds to somatostatin receptors that are overexpressed on many NET cells. By linking a radioisotope like Lutetium-177 or Yttrium-90 to Octreotide, the radioactive substance is selectively delivered to the NET cells while sparing most healthy tissues. Once bound, the radioisotope decays and releases radiation that damages the cancer cell's DNA and induces cell death.
Mechanism of Action
All NET cells exhibit somatostatin receptors to different extents. PRRT works by using this difference between cancerous and normal cells to selectively target the radiation. The Octreotide peptide acts as a "guided missile" to precisely deliver the radioisotope to NET cells. Compared to traditional external beam radiotherapy which exposes large areas to radiation, PRRT allows internal and more focussed radiation exposure only in the tumour regions. This translates to better treatment efficacy with relatively fewer side effects.
Growing Clinical Evidence
Over the last decade, numerous clinical studies from Italy and other European countries have demonstrated the benefits of Italy Peptide Receptor Radionuclide Therapy for advanced and metastatic NETs. Research conducted at the Sapienza University of Rome showed PRRT with Lutetium-177 led to disease control rates of over 80% in midgut NET patients after just two treatment cycles. Similarly, a multi-centre trial coordinated from hospitals in Milan found PRRT significantly delayed disease progression compared to the previous traditional standard of care. As more data emerged, major oncology societies now recommend considering PRRT for unresectable and somatostatin receptor positive NETs.
Availability in Italy
Riding on the promising research outcomes, the Italian Ministry of Health approved PRRT for reimbursed use in NETs back in 2012. This paved the way for regulated availability across public and private hospitals. Currently over 15 dedicated nuclear medicine departments in major cities like Rome, Milan, Turin and Naples offer the therapy. Specialist centers like the National Tumor Institute in Milan have extensive experience treating over 500 NET patients with PRRT. Access to this new treatment option is also part of the Italian government's efforts to establish network of centers of excellence for rare cancers like NETs.
Improving Outcomes
Multiple studies from various Italian centers have consistently reported PRRT achieving disease control rates over 80%, even in patients with advanced metastatic disease. A recent analysis of over 300 NET patients treated with Lutetium-177 PRRT at four Italian sites found median progression free survival to be 40 months. Remarkably, one-third of patients achieved complete remission, underscoring the therapy's potential as a cure. Research is also ongoing to optimize PRRT by combining it with other targeted drugs and cytotoxic chemotherapy in select cases. Overall, PRRT is undoubtedly improving outcomes for NET patients in Italy who previously had few effective long-term treatment options.
Managing Side Effects
As with most forms of radiotherapy, low blood counts requiring transfusions are a potential side effect of PRRT. However, specialized centers in Italy have established protocols to closely monitor patients and rapidly intervene if needed. Other relatively mild side effects seen occasionally include nausea, vomiting and fatigue. No significant kidney or liver damage have been reported if patients receive the recommended maximum cumulative activity dose over multiple cycles. With experienced physicians and support staff, most Italian centers are able to safely deliver outpatient PRRT withminimal hospitalization required.
The Future of PRRT
Given its promising efficacy demonstrated so far, PRRT is positioned to become the new standard of care for advanced somatostatin receptor positive NETs. In Italy, established specialists are further refining protocols to optimize outcomes. Upcoming multi-centre clinical trials will evaluate combining PRRT earlier in the disease course or adding new trageted drugs. Italian regulatory authorities are also working on plans to make PRRT part of national cancer care guidelines and accessible for eligible patients through universal public health coverage. With continued research and development, PRRT's role in successfully managing NETs in Italy is certain to grow even bigger in the future.
In conclusion, peptide receptor radionuclide therapy has emerged as an important new treatment modality for neuroendocrine tumors in Italy. Backed by strong clinical evidence, PRRT is delivering lasting benefits to patients and will likely become the standard of care for advanced somatostatin receptor positive NETs. Italian centers are leading global research efforts to maximize the full potential of this personalized radiotherapy approach for rare cancers.
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