title: PRRT: Defining the paradigm shift to achieve standardization and individualization.
abstract: Peptide receptor radionuclide therapy is a treatment for inoperable or metastatic neuroendocrine tumors. A key issue is the need to standardize the treatment and develop randomized controlled trials. Standardization would help define the characteristics of response, including progression-free survival; provide homogeneous phase II and III studies; delineate the position of peptide receptor radionuclide therapy in the therapeutic algorithm for neuroendocrine tumors; and establish the basis for approval by the regulatory authorities. Standardization of treatments is the starting point to redefine the treatment paradigm from a one-size-fits-all to a personalized treatment. To delineate the treatment paradigm, treatments should be optimized for efficacy and minimization of long-term toxicity, through dosimetry, and adapted to each individual, including relevant patient characteristics. Although differences in therapy outcomes may be explained by the specific absorbed dose (or biologically effective dose), they may also be related to discrete tumor- and patient-specific features. In this respect, a particular area of investigation is the assessment of genetic elements regulating tumor cell proliferation, especially those involved in the response to cytotoxic therapies.
authors.affiliation: Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy Department of Gastroenterological Surgery, Yale University School of Medicine, New Haven, Connecticut; and lisa.bodei@ieo.it.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bodei
authors.affiliation: Department of Gastroenterological Surgery, Yale University School of Medicine, New Haven, Connecticut; and.
authors.forename: Mark
authors.initials: M
authors.lastname: Kidd
authors.affiliation: THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Baum
authors.affiliation: Department of Gastroenterological Surgery, Yale University School of Medicine, New Haven, Connecticut; and.
authors.forename: Irvin M
authors.initials: IM
authors.lastname: Modlin
mesh_terms: D001984:Bronchial Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D018572:Disease-Free Survival; D006801:Humans; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D009683:Nuclear Medicine / Q000592:standards*; D015282:Octreotide / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D057285:Precision Medicine; D011868:Radioisotopes / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D018000:Receptors, Peptide / Q000627:therapeutic use*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D016896:Treatment Outcome
chemical_list: D011868:Radioisotopes; D019275:Radiopharmaceuticals; D018000:Receptors, Peptide; D015282:Octreotide
keywords: PRRT; individualization; standardization