PEPTIDE RECEPTOR RADIONUCLIDE THERAPY HOW, WHY AND WHEN
|
|
- Dwight Howard
- 5 years ago
- Views:
Transcription
1 PEPTIDE RECEPTOR RADIONUCLIDE THERAPY HOW, WHY AND WHEN Richard P. Baum, MD, PhD THERANOSTICS Center for Molecular Radiotherapy & Molecular Imaging ENETS Center of Excellence, Zentralklinik Bad Berka, Germany
2 Lecture Outline Personalized Medicine, Precision Oncology, THERANOSTICS Molecular imaging - the importance of PET/CT for selection of patients and in F/U Peptide Receptor Radiotherapy (PRRT) of NETs Results Zentralklinik Bad Berka in 1048 patients Results RCT NETTER-1 Future prospects - new peptides - new treatment combinations
3 Proteomics Metabolomics Serum Biomarker CTC Detection Multimodal Imaging PET/CT, PET/MR Structure Function Molecular Biology Patient History Familiy hx / Demographics Environmental Risk Factors / Treatments Precision Oncology Personalized Medicine Early Diagnosis, Risk Assessment Therapy Selection and Monitoring Epidemiology / Prevention Gen Expr Profile Tissue arrays Tumor Cell Genetics Genetics SNPs NGSequencing Adpted from Markus Schwaiger
4 Personalized Medicine The right treatment, for the right patient, at the right time, at the right dose»not anymore targeting the disease but the specific tumor of a patient The concept of PM has now been extended to Personalized Health Care that includes all steps relevant for the cure of the patient at an individual level from the first sign of disease up to full recovery, including the physicians, the technologies, the drugs and of course all economic aspects, but also extended to the environment, relatives, nurses Theranostics Theranostics is the combination of a Diagnostic Tool that helps to define the right Therapeutic Tool for a specific disease we see what we treat. The first Theranostics World Congress (TWC) in NM was organized in 2011 at Zentralklinik Bad Berka (>400 participants from 56 countries). Term coined first by PharmaNetics CEO John Funkhouser in 1998 at the same time the concept of Personalized Medicine appeared. Concerning radioisotopes, the term THERAGNOSTICS was created by Suresh Srivastava (Brookhaven National Laboratory). The most prominent and oldest application is radioiodine (switch of the radionuclide from diagnosis to radionuclide therapy). Molecular Nuclear Medicine and THERANOSTICS within MNM are definitely part of Personalized Health Care.
5 PubMed-derived number of publications including the term theranostic or theragnostic during each year from 2001 to 2017 (search performed July 16, 2017). Ken Herrmann et al. J Nucl Med 2017;58:1S-2S (c) Copyright 2014 SNMMI; all rights reserved
6 From Trial and Error Medicine to Personalized Medicine New paradigm: personalized medicine Observation Test Action Predictable Response Breaking the cycle of trial and error medicine PRECISION ONCOLOGY Targeted radionuclide therapy has unique promise for personalized treatment of cancer, because both the targeting vehicle and the radionuclide can be tailored to the individual patient. Courtesy Damian Wild
7 Creativity Paul Ehrlich Side Chain Theory Amboceptors and formation of antitoxins Corpora non agunt nisi fixata Zauberkugeln (Magic Bullits) Frankfurt/Main (1899) Nobel Prize in Physiology or Medicine 1908 The goundbreaking idea and basic principle of how molecules are talking to each other
8 Somatostatin Receptors Ala-Gly-Cys-Lys-Asp-Phe-Phe -Trp-Lys-Thr-Phe-Thr-Ser-Cys SST-14 (1973) 5 subtype receptors (SSTR1-5) predominant expression of SSTR2 in most NET tumours SSTR1 (4): Prostate, Sarcoma some: Pheochromocytma, GEP SSTR3: Inactive Pituitary Adenoma SSTR5: Gastric Carcinomas, GH Pituitary A. Reubi EJNM 2001
9 THERANOSTIC PAIRS Targeted Molecular Imaging and Therapy WE TREAT WHAT WE SEE Schematic Representation of a Drug for Imaging and Targeted Therapy pharmacokinetics/biodistribution modifier Target Ligand Linker Chelator Lock Key 68 Ga, 90 Y, 177 Lu Targets Antigens e.g. CD20, HER2) GPCR e.g. SSTR Enzymes & inhibitors e.g. PSMA Transporters Molecular Address Antibodies, minibodies, Affibodies, SHALs, aptamers Regulatory peptides (agonists & antagonists) Amino Acids Reporting Unit 99m Tc, 111 In 68 Ga, 44 Sc, 152 Tb, 64 Cu Cytotoxic Unit 90 Y, 177 Lu 225 Ac, 213 Bi Courtesy Helmut Mäcke (modified)
10 Somatostatin Analogs: Improvement of SST Receptor Affinity D-Phe Cys Tyr D-Trp D-Phe Cys *I-Tyr D-Trp Thr-ol Cys Thr Lys Thr-ol Cys Thr Lys D-Phe Cys Phe D-Trp TOC I*-TOC Thr-ol Cys Thr Lys HA-DOTATATE OCTREOTIDE DOTA D-Phe Cys Tyr D-Trp DOTA D-Phe Cys *I-Tyr D-Trp Thr-ol Cys Thr Lys Thr Cys Thr Lys DOTA-TOC DOTA-TATE Wester HJ, Schottelius M et al. 2013
11 From..Tide to..tate Affinity profiles of DOTA-octapeptides (IC 50 ) for hsst1 5 receptors subtypes hssr1 hssr2 hssr3 hssr4 hssr5 Ga DOTA NOC > ± 0,4 40 ± ± ± 1,6 Ga DOTA TOC > ± 0,5 613 ± 140 < ± 21 Ga DOTA TATE > ± 0.04 > ± ± 18 IC 50 values are in nmol/l (mean±sem)
12 90 Yttrium versus 177 Lutetium Y-90 Lu-177 ß - max kev high energy pure beta emitter max. tissue penetration 12 mm tumour lesions > 1 g inhomogenous tumours (no micrometastases) 90 Y 177 Lu ß - γ max. 498 kev 208 kev low energy max. tissue penetration 2 mm small tumour lesions micrometastases < 1 g
13 Radioparmaceuticals SST analogue 90 Y D-Phe Cys Tyr D-Trp Lys Thr(ol) Cys Thr Chelator = DOTA 90 Y-DOTA-TOC D-Phe Cys Tyr 177 Lu D-Trp Lys 177 Lu-DOTA-TATE Thr Cys Thr
14 Ga-68 Generator System TiO 2 based Simultaneous use of several generators Developed in close collaboration between Radiopharmacy PET/CT Center, Zentralklinik Bad Berka and Institute of Nuclear Chemistry Johannes Gutenberg-Universität, Mainz, Germany Zhernosekov K, Filosofov DV, Baum RP. Rösch F J Nucl Med 2007 (Oct); 48: Ga β m 68 Ga-elution, purificaton and synthesis module First clinical use in 2004, up to now over 12,000 studies done at ZKL Bad Berka
15 CARDIAC metastasis also a suitable target for PRRT! Ga-68 DOTATATE PET MIP CT transverse Ga-68 DOTATATE PET/CT - coronal MRI - transverse Ga-68 DOTATATE PET/CT transverse Metastatic functional highly differentiated NEN of terminal ileum Theranostics Research Center, Zentralklinik Bad Berka, ENETS Center of Excellence, Germany
16 Announcement of approval of There a
17 PRRT of SSTR positive tumors NET family and beyond medullary thyroid Thyroid C cells Adrenal medulla & paraganglia phaeochromocytoma paraganglioma neuroblastoma Pancreatic endocrine cells dispersed NET cells with somatostatin receptors islet cell tumors, insulinoma gastrinoma, glucagonoma VIPoma and others GI endocrine cells midgut NEN undifferentiated NET Bronchopulmonary carcinoids small cell lung ca Leptomeninx & glial meningiomas glioma Miscellaneous ovary, cervix, endometrium, breast, kidney, larynx, sinus, salivary glands Adapted from Michael Hofman
18 somatostatin first isolated (Roger Guillemin) octreotide synthesis scintigraphy with 123 I-octreotide 40 years ago!! Autoradiography In-octreotide first employed 1992 five G-protein coupled somatostatin receptors (sst1 5), identified and cloned In-octreotide registered Scintigraphy First PRRT with high-dose 111 In-octreotide 1996 First 90 Y-octreotide PRRT - Basel PRRT First 177 Lu-octreotate PRRT - Rotterdam Phase III registration trial of 177 Lu-octreotate 2016 Completion of NETTER-1 Trial
19 First Y-90 DOTATOC* Peptide Receptor Radionuclide Therapy in Germany July 1997 * provided by Helmut Mäcke
20 Patient Selection for Personalized PRRT The Bad Berka Score (BBS) SUV on receptor PET/CT (referrals: OctreoScan K.S.) Renal function (GFR and TER / creatinine & BUN) Hematological status (blood counts) Liver involvement Extrahepatic tumor burden Ki-67 index / tumor grade FDG status (glucose hypermetabolism of tumors/mets) Tumor dynamics (doubling time, new lesions) Karnofsky performance index Weight loss Time since first diagnosis Functional activity of tumor Previous therapies
21 PATIENT EVALUATION BEFORE PEPTIDE RECEPTOR RADIONUCLIDE THERAPY (PRRT) Treatment decisons based on Ga-68 SMS receptor PET/CT: Bad Berka scoring system is based on SUVs not on visual analogue scales as previously derived from OctreoScans
22 SSTRI FDG The NETPET Grade
23 PRRT THE BAD BERKA CONCEPT Dedicated multidisciplinary team of experienced NET specialists Selection of patients for PRRT based on Bad Berka Score (BBS) i.e. clinical aspects / molecular features: progressive tumors, uncontrolled symptoms despite maximum conventional therapy / high SMS-receptor expression (as determined by receptor PET/CT) Individualized therapy plan for each patient by tumor board consensus Frequent cycles (4-6, up to 12) applying low/intermediate doses of radioactivity: long term low dose, not short term high dose concept Combined use of Lu-177 and Y-90 (in sequence, in few concurrent) Intra-arterial PRRT (for liver metastases & inoperable primary tumors) Standardized evaluation before therapy and systematic restaging All clinical data entered into a prospective clinical database (since 2004)
24 BAD BERKA PROTOCOL FOR PRRT Studies before therapy Renal scintigraphy [ 99m Tc- MAG 3 ] GFR measurement [ 99 Tc- DTPA] 90 Y / 177 Lu-DOTA-TATE Peptide Receptor Radiotherapy Receptor PET/CT* [ 68 Ga-DOTA-NOC] Infusion of aminoacid solution (- 0.5 until 4 hrs) plus Gelofusine - 2 days 0 Infusion (15 min.) of 90 Y / 177 Lu- DOTA-TATE days Studies under /after therapy, dosimetry 177 Lu- DOTA-TATE WB scan [planar scans for dosimetry] 177 Lu- DOTA-TATE- SPECT of the tumor region Blood sampling Urine sampling * Since July Previously, Tc-99m EDDA Hynic TOC (planar & SPECT) was performed. In selected patients, also F-18 FDG and / or F-18 fluoride PET/CT is performed as well as MRI of the liver / bones
25 RADIOPEPTIDE THERAPY (ZKL BAD BERKA) As of September 30, 2017 Patients treated n = 1494 Therapy cycles n = 5384 Lu-177 n = 3710 Y-90 n = 1712 Bi-213 n = 1 Somatostatin receptor positive neuroendocrine tumors Y-90 Lu-177 Mean 3,35 GBq 6.5 GBq Max. 9,50 GBq GBq Age: 4 85 years Median: 59.9 years
26 Center for Molecular Radiotherapy, Zentralklinik Bad Berka Primary tumors of patients with metastatic NETs treated by PRRT n=1494 patients THERANOSTICS Center for Molecular Radiotherapy and Molecular Radiotherapy, Zentralklinik Bad Berka
27 PATIENT SELECTION Patients screened for eligibility since 2004 N=2294 Not eligible N= 570 Eligible but PRRT not performed N= 676 Treated with PRRT between 2004 and 2015 N=1048 Included in the intention to treat analysis N=1048 Progression-free survival as determined by RECIST as well as by 68 Ga somatostatin receptor (SSTR) PET/CT using the EORTC response criteria was analyzed in all patients.
28 OVERALL SURVIVAL ACCORDING TO PRIMARY TUMORS Patients with NENs of small intestinal origin (69 months % CI) had a better survival than those with other primary tumors Proportion event free (%) Lung Pancreas Small bowel CUP other Time (months) Number at risk: Total Bronchial Pancreas Small bowel CUP Other Kaplan-Meier plot
29 Presented at ENETS 2017 After surgery of the primary tumor, pts. have a better survival after PRRT. These effects may result from selection bias, however, there are strong indicators for clinical practice that primaries should be removed when feasible.
30
31 THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka Neuroendocrine neoplasm of the right kidney with extensive bilateral liver metastases (size 3.7 cm in S7) and retroperitoneal lymph node (size up to 6.5 cm) and bone metastases MOLECULAR RESPONSE BY 68 GA DOTA-TOC PET/CT IMPROVEMENT OF KIDNEY FUNCTION IN A PATIENT WITH A SINGLE KIDNEY May 2009 before PRRT Sept after 1st PRRT Jan mo after 2nd PRRT TER 97 ml/min (35 %) TER 147 ml/min (54 %) TER 202 ml/min (74 %)
32 Serial renal function assessment in a patient treated with 10 PRRT cycles over 9 years by measurement of the tubular extraction rate (TER) using Tc-99m MAG3.
33 Bodei L et al. Eur J Nucl Med Mol Imaging 2015; 42:5-19 Hematological toxicity of PRRT MDS/AML in <3% of patients
34 despite the lack of homogeneity among studies EFFICACY Tumor shrinkage Symptom relief and QoL improvement Biomarker reduction Impact on survival TOLERABILITY Generally well tolerated Generally mild acute side effects: AA-related: nausea, vomiting PRRT-related: fatigue, mild hair loss (Lu-tate), rare exacerbation of syndromes Chronic and permanent effect on kidney, BM, (testes) Generally mild if necessary precautions are taken
35 A landmark publication in Theranostics TRC N Engl J Med 2017;376:
36 Presented by Richard P. Baum Participating Sites in 51 Centers - 11 Countries
37 177 Lu-DOTATATE: Compare PFS Octreotide LAR: Courtesy Lisa Bodei
38 NETTER-1 RCT Results in SI-NET N = 229 (ITT) Number of events: 90 Long Progression-Free Survival 177 Lu-Dotatate Median PFS: Not reached 177 Lu-Dotatate: 23 Oct 60 mg LAR: 67 Hazard ratio: 0.21 [ ] p < % reduction in the risk of disease progression/death Octreotide LAR 60 mg Median PFS: 8.4 months Estimated Median PFS Lu-DOTATATE arm 40 month All progressions centrally confirmed and independently reviewed for eligibility (SAP) Presentation Presidential Session II of the 18th ECCO 40th ESMO European Cancer Congress 2015, 27 September 2015, abstract 6LBA, Vienna
39 Overall Survival (interim analysis) N = 229 (ITT) Number of deaths: Lu-Dotatate: 13 Octreotide 60 mg LAR: 22 P = Presented by Richard P. Baum
40 Safety and Tolerability (Safety Set; n=221) 177 Lu-Dotatate (n=111) Octreotide LAR 60mg (n=110) Any adverse event 106 (96%) 95 (86%) Related to treatment 95 (86%) 34 (31%) Serious adverse events 29 (26%) 26 (24%) Withdrawals due to adverse events Related to treatment 10 (9%) 1 (1%) 7 (6%) 10 (9%) Related to treatment 5 (5%) 0 (0%) Presented by Richard P. Baum
41 Creatinine Clearance Renal function remains stable over the 2-year observation period 177 Lu-Dotatate (N = 111) Octreotide LAR (N = 110) Grade 3/4 Grade 3/4 Creatinine increased 0% 0% Presented by Richard P. Baum
42 Summary and Conclusions Final analysis : In this first prospective randomized study in patients with progressive metastatic midgut NETs, 177 Lu-Dotatate was superior to Octreotide 60 mg in terms of: PFS (Not reached vs 8.4 months, p<0.0001) ORR (18% vs 3%, p=0.0008) Interim analysis suggests increased OS (13 vs 22 deaths) 177 Lu-Dotatate demonstrates a favorable safety profile 177 Lu-Dotatate has a major therapeutic benefit for patients progressing under SSAs Presented by Richard P. Baum
43 The COMPETE study Controlled, Open-label, Multicentre study of PRRT with 177 Lu-Edotreotide compared to targeted molecular Therapy with Everolimus in neuroendocrine tumours of the pancreas (P-NET) and midgut Trial started in 2017
44 J Nucl Med 2011; 52:
45 J Nucl Med 2011; 52: Conclusion: GHS/QOL, KPS, and symptoms improved significantly after Lu-177 octreotate therapy, and there was no significant decrease in QOL in patients who had no symptoms before therapy. In patients who had suboptimal scores for GSH/QOL or symptoms before therapy, a clinically significant improvement was demonstrated. Our results indicate that Lu-177 octreotate therapy not only reduces tumors and prolongs overall survival, but also improves the patients self-assessed QOL.
46 Quality of life findings in the NETTER-1 Study Jonathan Strosberg Associate Professor H. Lee Moffitt Cancer Center Tampa, FL
47 Methods: QOL analysis QOL surveys obtained every 12 weeks (EORTC QLQ C-30 and GI-NET 21 questionnaires). Answers are scored on a point scale. A 10-point change in score over time is considered clinically significant. Percentage of patients on each arm of the study with QOL changes 10 points from baseline were recorded at each 12-week timepoint from week Due to higher rates of progression/death on the octreotide arm, relative number of patients on this arm is increasingly lower at each timepoint. Aaronson et al. JNCI 1993; 85:365-76
48 Global Health Status How would you rate your overall health during the past week How would you rate your overall quality of life during the past week * * In mean, during the study, global health status was* : improved in 28% of the patients in 177 Lu-DOTA-TATE (177-Lu) vs. 15% in the Octreotide LAR arm (Oct)* worsened in 18% of the patients in 177 Lu-DOTA-TATE (177-Lu) vs. 26% in the Octreotide LAR arm (Oct) 48 * Statistically significant difference between the arms (p 0.05) weeks 24 and 48
49 Physical functioning Do you have any trouble doing strenuous activities like carrying a heavy shopping bag or suitcase Do you have any trouble taking a long walk Do you have any trouble taking a short walk outside of the house Do you need to stay in bed or a chair during the day Do you need help with eating, drinking, washing yourself or using the toilet In mean, during the study, global physical functioning was : improved in 18% of the patients in 177- Lu vs. 5% in the Octreotide LAR arm (Oct) worsened in 15% of the patients in 177- Lu vs. 21% in the Octreotide LAR arm (Oct) 49
50 Role functioning Were you limited in doing either your work or other daily activities Were you limited in pursuing your hobbies or other leisure time activities In mean, during the study, global role functioning was : improved in 29% of the patients in 177-Lu vs. 18% in the Octreotide LAR arm (Oct) worsened in 20% of the patients in 177-Lu vs. 29% in the Octreotide LAR arm (Oct) 50
51 Pain Have you had pain Did pain interfere with your daily activities In mean, during the study, global pain was : improved in 41% of the patients in 177-Lu vs. 28% in the Octreotide LAR arm (Oct) worsened in 17% of the patients in 177-Lu vs. 25% in the Octreotide LAR arm (Oct) 51
52 Diarrhea Have you had diarrhea * In mean, during the study, diarrhea: improved in 39% of the patients in 177-Lu vs. 23% in the Octreotide LAR arm (Oct) worsened in 19% of the patients in 177-Lu vs. 23% in the Octreotide LAR arm (Oct) 52 * Statistically significant difference between the arms (p=0.05) at week 48.
53 Conclusions Treatment with 177 Lu-Dotatate is associated with improvement in quality of life in several key domains including global health and diarrhea. Non-statistically-significant improvement in QOL seen (more improvement/less worsening) observed with 177 Lu- Dotatate in most domains. No evidence of significantly decreased quality of life with 177 Lu-Dotatate observed in any domain. Limitation of study includes lack of blinding. Patients were aware of treatment assignment.
54 ENETS Guidelines 2016 Intestinal NET Pavel et al Neuroendocrinology 2016
55 ENETS Guidelines 2016 Pancreatic NET Pavel et al Neuroendocrinology 2016
56 Peptide Receptor Radiotherapy what does the future hold? Combination therapies PRRT+ o PRCRT (PRRT + chemotherapy) o PRIT (PRRT + immunotherapy) o Surgery (neoadjuvant / adjuvant PRRT, use of intraoperative probes) o TACE (transarterial chemoembolization) o SIRT (selected internal radiation therapy) o RFA (radiofrequency ablation) o Kinase inhibitors o Radiosensitizers Targeted alpha radiation therapy (ART, e.g. Bismuth-213, Actinium-225) Novel radioisotopes for imaging and therapy (theranostic pairs - Sc-44/Sc-47, Cu-64/Cu-67, Tb-152/Tb-149, Tb-155/Tb-161) Novel targets (e.g. SSR antagonists, CXCR4) Liquid biopsy (pcr and gene analysis for better selection of patients for PRRT, prognostication of efficacy of therapy and of possible side effects) Radiomics (selection of patients for PRRT, prognostication of therapy effects) DUO-PRRT i.e., using Y-90 and Lu-177 labeled SSA in sequence TANDEM-PRRT i.e., using Y-90 and Lu-177 labeled SSA simultaneously Intra-arterial PRRT Improvements in dosimetry (personalized and predictive dosimetry)
57 PeptideReceptorChemoRadioTherapy Australia Leading the Way: RCT of PRCRT Cohort A: pancreatic NETs: Lu-177 DOTATATE+CAPTEM vs. CAPTEM (control) Cohort B: small bowel NETs: Lu-177 DOTATATE+CAPTEM vs. Lu-DOTATATE (control)
58 online August 2017
59 Cancer-immunity cycle: Immunotherapeutic points of attack Adaptive immune system long-term remission Chen and Mellman, Immunity 2013
60 Phase 0 PRIT Trial Immune Modulation to enhance PRRT Efficacy - Treatment Scheme 3-4 Cycles NET Typer Check Point Typer Immune Function dx NET Typer Check Point Typer Immune Function dx NET Typer Check Point Typer Immune Function dx Biopsy CPI Tox check 5 7 d PRRT 177 Lu DOTATATE 7 d CPI 14 d CPI NETest NETest NETest NETest Liquid Biopsy Tests Liquid Biopsy Tests Liquid Biopsy Tests Liquid Biopsy Tests Primary Endpoint: Toxicity / Safety Secondary Endpoint: Biomarker Change associated with Respnse by RECIST & PERCIST
61 Jean-Claude Reubi, Bern, Switzerland Antagonist labels more sst 2 sites than agonist in human cancer tissues Agonist Lu DOTA-TATE Antagonist Lu DOTA-BASS Total ns Total ns Renal Cell Ca Br4 Expo 40h P-329 II Expo 40h NHL Expo 40h Breast-Tu Ha 7 Expo 17h 60
62 Extensive NET of pancreas with liver metastasis SMS-Agonist Ga-68 DOTATOC SMS-Antagonist Ga-68 NODAGA JR11 Antagonist labels more sst 2 sites than agonist in cancer patients leading to higher diagnostic sensitivity (first in human study at Zentralklinik Bad Berka)
63
64 Comparison of 177 Lu-DOTATATE and 177 Lu-DOTA-JR11 dosimetry (G3) Patient with NEC (G3) of the bladder with lymphnode and uterus metastases, shows progression after surgery and treatment with Somatostatin analogues 68 Ga-DOTA-TATE PET 177 Lu-DOTA-TATE (Agonist) Isodose curves based on 3D voxel dosimetry analysis 177 Lu-DOTA-JR11 (Antagonist) Isodose curves based on 3D voxel dosimetry analysis Limited kidney function Creatinine clearence: 54 ml/min (norm ml/min) mean dose: 1.4 Gy/GBq Tumor-to-kidney dose ratio: 1.1 sst 2 affinity profile (IC 50 ) 0.7 ± 0.15 nm mean dose: 5.7 Gy/GBq Tumor-to-kidney dose ratio: 2.5 sst 2 affinity profile (IC 50 ) 1.5 ± 0.4 nm D. Wild et al. J Nucl Med 2014;55:
65 Dosimetry Perspectives - New Isotopes Pre-therapeutic organ and tumor dosimetry using receptor PET/CT and longer lived positron emitters, e.g. Sc-44,Cu-64 Tb-152 and comparison with Ga-68 results. Selection of the optimal peptide and radionuclide for individual therapy of each patient ( personalized dosimetry ) by pretherapeutic measurement of organ and tumor doses. Y-86 DOTA-NOC Receptor PET/CT
66 Ga-68 DOTATOC --- PET/CT --- Sc-44 DOTATOC 4h p.i. Personalized dosimetry
67 SUMMARY TAKE HOME MESSAGES PRRT is effective and well tolerated even in very advanced NET cases Median overall survival from start of treatment: > (up to >90) months PRRT leads to significant improvement of clinical symptoms Cure is rarely possible - but excellent palliation can be achieved PRRT: part of the clinical algorithms of major scientific & clinical societies Standardized treatments are usually applied - guidelines are available Significant kidney damage can be avoided (or reduced) PRRT should be performed at specialized centres: NET patients need highly individualized interdisciplinary treatment and long term care. Future perspectives: personalized treatment based on Genetic characteristic & clinical features Dosimetry Biological information regarding the tumor cell and its microenvironment New interface between molecular imaging and circulating biomarkers
THERANOSTICS MOLEKULARE BILDGEBUNG MITTELS PET/CT
THERANOSTICS MOLEKULARE BILDGEBUNG MITTELS PET/CT UND RADIOREZEPTORTHERAPIE VON NET Richard P. Baum Klinik für Molekulare Radiotherapie / Zentrum für Molekulare Bildgebung (PET/CT) ENETS Center of Excellence,
More informationQOL Improvements in NETTER-1 Phase III Trial in Patients With Progressive Midgut Neuroendocrine Tumors
QOL Improvements in NETTER-1 Phase III Trial in Patients With Progressive Midgut Neuroendocrine Tumors Abstract C-33 Strosberg J, Wolin E, Chasen B, Kulke M, Bushnell D, Caplin M, Baum RP, Kunz P, Hobday
More informationPeptide Receptor Radionuclide Therapy (PRRT) of NET
Peptide Receptor Radionuclide Therapy (PRRT) of NET Dr. Tuba Kendi Associate Prof of Radiology, Mayo Clinic, Rochester, MN 2014 MFMER slide-1 Relevant Financial Relationship(s) None Off Label Usage None
More informationPeptide Receptor Radionuclide Therapy using 177 Lu octreotate
Peptide Receptor Radionuclide Therapy using 177 Lu octreotate BLR Kam, Erasmus Medical Centre, Rotterdam DJ Kwekkeboom, Erasmus Medical Centre, Rotterdam Legal aspects As 177 Lu-[DOTA 0 -Tyr 3 ]octreotate
More informationSomatostatin receptor agonists and antagonists Melpomeni Fani
Somatostatin receptor agonists and antagonists Melpomeni Fani Clinic of Radiology and Nuclear Medicine University of Basel Hospital, Switzerland Somatostatin and somatostatin receptors Human Somatostatin
More informationNet Cancer Day Webinar
Net Cancer Day Webinar The webinar will start shortly Please make sure to dial in using the numbers provided or in the upper right hand side of the screen select Switch to Interactive Meeting to enable
More informationSession 6 NEW TECHNIQUES IN RADIATION TREATMENT. Chairman : Françoise MORNEX
Session 6 NEW TECHNIQUES IN RADIATION TREATMENT Chairman : Françoise MORNEX INTERNAL IRRADIATION FOR ENDOCRINE TUMORS Emmanuel DESHAYES INTERNAL IRRADIATION FOR ENDOCRINE TUMORS Dr Emmanuel DESHAYES Nuclear
More informationNET εντέρου Τι νεότερο/ Νέες μελέτες. Μαντώ Νικολαΐδη παθολόγος-ογκολόγος ΜΗΤΕΡΑ
NET εντέρου Τι νεότερο/ Νέες μελέτες Μαντώ Νικολαΐδη παθολόγος-ογκολόγος ΜΗΤΕΡΑ NET: A Diverse Group of Malignancies 1-3 Wide spectrum of malignancies arising in neuroendocrine cells throughout the body
More informationNeuroendocrine Tumors Positron Emission Tomography (PET) Imaging and Peptide Receptor Radionuclide Therapy
Neuroendocrine Tumors Positron Emission Tomography (PET) Imaging and Peptide Receptor Radionuclide Therapy Lawrence Saperstein, M.D. Assistant Professor of Radiology and Biomedical Imaging Chief, Nuclear
More informationCutting Edge Treatment of Neuroendocrine Tumors
Cutting Edge Treatment of Neuroendocrine Tumors Daneng Li, MD Assistant Clinical Professor Department of Medical Oncology & Therapeutics Research City of Hope Click to edit Master Presentation Date DISCLOSURE
More informationCutting Edge Treatment of Neuroendocrine Tumors
Cutting Edge Treatment of Neuroendocrine Tumors Daneng Li, MD Assistant Clinical Professor Department of Medical Oncology & Therapeutics Research City of Hope Click to edit Master Presentation Date DISCLOSURE
More informationTheranostics in Nuclear Medicine
Theranostics in Nuclear Medicine Patrick FLAMEN, MD, PhD Head Nuclear Medicine Institut Jules Bordet Université Libre de Bruxelles (U.L.B.) n Theranostics in Nuclear Medicine n A form of (nuclear) diagnostic
More informationFMU-ICRP Workshop on Radiological Protection in Medicine Current Status in Radionuclide Therapy Tuesday, October 3, 2017 Makoto Hosono, MD PhD Kindai
FMU-ICRP Workshop on Radiological Protection in Medicine Current Status in Radionuclide Therapy Tuesday, October 3, 2017 Makoto Hosono, MD PhD Kindai University Faculty of Medicine, Osaka, Japan Current
More informationMEDICAL POLICY SUBJECT: PEPTIDE RECEPTOR RADIONUCLIDE THERAPY (PRRT)
MEDICAL POLICY SUBJECT: PEPTIDE RECEPTOR PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product (including an Essential
More informationA New Proposal for Metabolic Classification of NENs Stefano Severi IRST Meldola Italy
RADIONUCLIDE THERAPY AND ALLIED SCIENCE President: Giovanni Paganelli Chairman: Maria Salvato Baltimore USA Domenico Barone Meldola Italy A New Proposal for Metabolic Classification of NENs Stefano Severi
More informationCase Report. Ameya D. Puranik, MD, FEBNM; Harshad R. Kulkarni, MD; Aviral Singh, MD; Richard P. Baum, MD, PhD ABSTRACT
Case Report 8-YEAR SURVIVAL WITH A METASTATIC THYMIC NEUROENDOCRINE TUMOR: EMPHASIS ON REDEFINING TREATMENT OBJECTIVES USING PERSONALIZED PEPTIDE RECEPTOR RADIONUCLIDE THERAPY WITH 177 Lu- AND 90 Y-LABELED
More informationReview of Gastrointestinal Carcinoid Tumors: Latest Therapies
Review of Gastrointestinal Carcinoid Tumors: Latest Therapies Arvind Dasari, MD, MS Department of Gastrointestinal Medical Oncology The University of Texas MD Anderson Cancer Center Houston, TX, USA Neuroendocrine
More informationMEDICAL MANAGEMENT OF METASTATIC GEP-NET
MEDICAL MANAGEMENT OF METASTATIC GEP-NET Jeremy Kortmansky, MD Associate Professor of Clinical Medicine Yale Cancer Center DISCLOSURES: NONE Introduction Gastrointestinal and pancreatic neuroendocrine
More informationNeuroendocrine Tumour Theranostics
Neuroendocrine Tumour Theranostics Lisa Bodei Director of Targeted Radionuclide Therapy Molecular Imaging and Therapy Service Memorial Sloan Kettering Cancer Center New York Friday, April 13, 2018 Disclosure
More informationLu 177-Dotatate (Lutathera) Therapy Information
Lu 177-Dotatate (Lutathera) Therapy Information Information for Lu 177-dotatate therapy also known as Lutathera, for the treatment of metastatic midgut neuroendocrine tumor and other metastatic neuroendocrine
More informationLu-DOTATATE PRRT dosimetry:
177 Lu-DOTATATE PRRT dosimetry: From theory to practice Silvano Gnesin Medical Physics department Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland Gwennaëlle Marin Medical
More informationMEDICAL POLICY EFFECTIVE DATE: 06/21/07 REVISED DATE: 05/14/08, 04/16/09, 03/18/10, 03/17/11, 03/15/12, 02/21/13, 02/20/14, 02/19/15
MEDICAL POLICY PAGE: 1 OF: 6 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.
More informationEXOCRINE: 93% Acinar Cells Duct Cells. ENDOCRINE: 5% Alpha Cells Beta Cells Delta Cells Others
EXOCRINE: 93% Acinar Cells Duct Cells Digestive Enzymes Trypsin: Digests Proteins Lipases: Digests Fats Amylase: Digest Carbohydrates ENDOCRINE: 5% Alpha Cells Beta Cells Delta Cells Others Hormones Glucagon
More informationMEDICAL POLICY SUBJECT: PEPTIDE RECEPTOR RADIONUCLIDE THERAPY (PRRT)
MEDICAL POLICY SUBJECT: PEPTIDE RECEPTOR RADIONUCLIDE THERAPY (PRRT) POLICY NUMBER: 7.01.78 CATEGORY: Technology Assessment EFFECTIVE DATE: 06/21/07 REVISED DATE: 05/14/08, 04/16/09, 03/18/10, 03/17/11,
More informationLutetium-177 PSMA (LuPSMA) Theranostic Phase II trial: Efficacy, safety and QoL in patients
Lutetium-177 PSMA (LuPSMA) Theranostic Phase II trial: Efficacy, safety and QoL in patients with castrate-resistant prostate cancer treated with LuPSMA M. S. Hofman, S. Sandhu, P. Eu, P. Jackson, T. Akhurst,
More informationPhysical Bases : Which Isotopes?
Physical Bases : Which Isotopes? S. Gnesin Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland 1/53 Theranostic Bruxelles, 2 Octobrer 2017 Theranostic : use of diagnostic
More informationTRACTAMENT ONCOLÒGIC DELS TUMORS NEUROENDOCRINS METASTÀSICS
TRACTAMENT ONCOLÒGIC DELS TUMORS NEUROENDOCRINS METASTÀSICS Jaume Capdevila Unitat de Tumors GI i Endocrins Hospital Universitari Vall d Hebron Barcelona Experts, acollidors i solidaris OUTLINE BACKGROUND
More informationPRRT in Management of NETs. Ioannis Karfis, MD PhD Assistant Head of Clinic Nuclear Medicine Dept IJB, Brussels
PRRT in Management of NETs Ioannis Karfis, MD PhD Assistant Head of Clinic Nuclear Medicine Dept IJB, Brussels THERAPEUTIC TARGETS in NENs Pavel M: Neuroendocrinology 2013;97:99-112 THERAPEUTIC ARENA in
More informationHow to optimize diagnostic nuclear techniques?
How to optimize diagnostic nuclear techniques? Prof. Dr. Christophe Deroose Nuclear Medicine - University Hospitals Leuven (UZ Leuven) Department of Imaging & Pathology KU Leuven Leuven Cancer Institute
More informationThe PET-NET Study 2016 CNETS Grant Award
The PET-NET Study 2016 CNETS Grant Award CANM Meeting April 21, 2017 Hagen Kennecke, MD, MHA, FRCPC Medical Oncology, BC Cancer Agency Associate Professor, University of British Columbia Raja Ampat, Indonesia
More informationGa68 Imaging. Roland HUSTINX Division of Nuclear Medicine and Oncologic Imaging Centre Hospitalier Universitaire de Liège Belgium
Ga68 Imaging Roland HUSTINX Division of Nuclear Medicine and Oncologic Imaging Centre Hospitalier Universitaire de Liège Belgium 68 Ga Produced by a 68 Ge/ 68 Ga generator Decays by positron emission
More informationTHERANOSTICS clinical aimshots in surgical warfare against well-differentiated neuroendocrine neoplasms
Featured Article Page 1 of 8 THERANOSTICS clinical aimshots in surgical warfare against well-differentiated neuroendocrine neoplasms ieter Hörsch 1, Harshad R. Kulkarni 2, Richard P. Baum 2 1 Internal
More informationNET und NEC. Endoscopic and oncologic therapy
NET und NEC Endoscopic and oncologic therapy Classification well-differentiated NET - G1 and G2 - carcinoid poorly-differentiated NEC - G3 - like SCLC well differentiated NET G3 -> elevated proliferation
More informationRadionuclide Therapy: History, Present and Future Promise. History of Radionuclide (RN) Therapy. History of RN Therapy 8/2/2017
Radionuclide Therapy: History, Present and Future Promise Bennett S. Greenspan, MD, MS Professor, Dept. of Radiology, MCG / AU President, SNMMI AAPM Annual Meeting, Denver, CO History Symposium 8/02/2017
More informationUnderstanding Biological Activity to Inform Drug Development
National Cancer Policy Forum Understanding Biological Activity to Inform Drug Development December 12, 2016 Wolfgang Weber Molecular Imaging and Therapy Service Department of Radiology RECIST Response
More informationPeptide Receptor Radiation Therapy (PRRT) in Patients with Neuroendocrine Tumors: The Edmonton Experience
Peptide Receptor Radiation Therapy (PRRT) in Patients with Neuroendocrine Tumors: The Edmonton Experience Sandy McEwan, M.B. F.R.C.P.C Chair, Department of Oncology University of Alberta Disclosures I
More informationQuantitative Theranostics in Nuclear Medicine
Quantitative Theranostics in Nuclear Medicine M. Lassmann Klinik und Poliklinik für Nuklearmedizin Direktor: Prof. Dr. A. Buck Contents What is Theranostics? Potential Targets Basic Principles of Quantitative
More informationTheragnostics Neuroendocrine and Prostate Cancer
Theragnostics Neuroendocrine and Prostate Cancer Target Audience: Pharmacists ACPE#: 0202-0000-18-080-L01-P Activity Type: Knowledge-based Target Audience: ACPE#: Activity Type: Disclosures Financial:
More informationDosimetry in Nuclear Medicine Therapies
Dosimetry in uclear Therapies F. Forrer Institut of uclear University ospital Basel uclear Therapies Radioiodine Phosphonates Metabolites (e.g. 131 I-mIBG) Radiopeptides Radioimmunotherapy Radiosynoviothesis
More informationMolecular Imaging Guided Therapy: The Perfect Storm. David M Schuster, MD Emory University Department of Radiology Atlanta, GA
Molecular Imaging Guided Therapy: The Perfect Storm David M Schuster, MD Emory University Department of Radiology Atlanta, GA Talk can be found at radiology.emory.edu Let s start with a case 74 year
More informationHot of the press. Γρηγόριος Καλτσάς MD FRCP Καθηγητής Παθολογίας Ενδοκρινολογίας ΕΚΠΑ
Hot of the press Γρηγόριος Καλτσάς MD FRCP Καθηγητής Παθολογίας Ενδοκρινολογίας ΕΚΠΑ Outline Diagnostic developments Histopathology Molecular Therapeutic developments Results on PRRT Telotristat in carcinoid
More informationDosimetry and radiobiology for Peptide Receptor Radionuclide Therapy
Dosimetry and radiobiology for Peptide Receptor Radionuclide Therapy Short-ranged particle emitters for targeted radionuclide therapy require specific dosimetry and radiobiology Mark Konijnenberg Melodi
More informationSIRT in the Management of Metastatic Neuroendocrine Tumors
SIRT in the Management of Metastatic Neuroendocrine Tumors Navesh K. Sharma, DO, PhD Assistant Professor, Departments of Radiation Oncology, Diagnostic Radiology and Nuclear Medicine Medical Director,
More informationDr. Sandip Basu Radiation Medicine Center (BARC) Tata Memorial Centre Annexe, Parel, Mumbai
Newer Radionuclide Therapies Dr. Sandip Basu Radiation Medicine Center (BARC) Tata Memorial Centre Annexe, Parel, Mumbai NICSTAR-2018 5 th -7 th March, 2018 A. Receptor over-expression in Tumors as Target:
More informationLutetium-DOTA TATE Treatment of inoperable GEP NETs
Logo 177 Lutetium-DOTA TATE Treatment of inoperable GEP NETs Dr. Augusto Llamas-Olier. Nuclear medicine department. Dr. Maria Cristina Martínez*, Dr. Alfonso Lozano** and Dr. Augusto Llamas-Olier*. *Nuclear
More informationRecent developments of oncology in neuroendocrine tumors (NETs)
Recent developments of oncology in neuroendocrine tumors (NETs) Marc Peeters MD, PhD Coordinator Multidisciplinary Oncological Center Antwerpen (MOCA) Head of the Oncology Department UZA, Professor in
More informationlutetium ( 177 Lu) oxodotreotide 370MBq/mL solution for infusion (Lutathera ) SMC No 1337/18 Advanced Accelerator Applications
lutetium ( 177 Lu) oxodotreotide 370MBq/mL solution for infusion (Lutathera ) SMC No 1337/18 Advanced Accelerator Applications 8 June 2018 The Scottish Medicines Consortium (SMC) has completed its assessment
More informationPreclinical imaging and therapy. Marion de Jong
Preclinical imaging and therapy Marion de Jong Content Introduction Preclinical Imaging Preclinical Therapy to raise awareness about problems related to translation of animal studies Radiopharmaceuticals
More informationPatient information file
Internal irradiation of neuroendocrine tumors with Yttrium-90-DOTATOC, a radiolabeled somatostatin analogue Patient information file Ladies and Gentlemen You are diagnosed with a neuroendocrine tumor and
More informationSmall-cell lung cancer (SCLC) accounts for 15% to 18% of
BRIEF REPORT Brief Report on the Use of Radiolabeled Somatostatin Analogs for the Diagnosis and Treatment of Metastatic Small-Cell Lung Cancer Patients Martina Sollini, MD,* Daniela Farioli, MS,* Armando
More informationDiabetes mellitus and its effects on all cause mortality after radiopeptide therapy for neuroendocrine tumors
Journal of Nuclear Medicine, published on September 15, 2016 as doi:10.2967/jnumed.116.180687 Diabetes mellitus and its effects on all cause mortality after radiopeptide therapy for neuroendocrine tumors
More informationGastrointestinal Neuroendocrine Tumors: A Closer Look at the Characteristics of These Diverse Tumors
Gastrointestinal Neuroendocrine Tumors: A Closer Look at the Characteristics of These Diverse Tumors Jaume Capdevila, MD, PhD Vall d'hebron University Hospital Vall d'hebron Institute of Oncology (VHIO)
More informationPSMA PET SCANNING AND THERANOSTICS IN PROSTATE CANCER KEVIN TRACEY, MD, FRCPC PRECISION DIAGNSOTIC IMAGING REGIONAL PET/CT CENTRE
PSMA PET SCANNING AND THERANOSTICS IN PROSTATE CANCER KEVIN TRACEY, MD, FRCPC PRECISION DIAGNSOTIC IMAGING REGIONAL PET/CT CENTRE DISCLOSURES/CONFLICTS NONE OBJECTIVES Understand current diagnostic role
More informationTeresa Alonso Gordoa Servicio Oncología Médica Hospital Universitario Ramón y Cajal
Teresa Alonso Gordoa Servicio Oncología Médica Hospital Universitario Ramón y Cajal Incidence per 100,000 EPIDEMIOLOGY Incidence rates of neuroendocrine tumors by primary tumor site 1.4 1.2 1.0 0.8 0.6
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GASTROINTESTINAL NEUROENDOCRINE GASTRO-ENTERO-PANCREATIC TUMOURS GI Site Group Neuroendocrine gastro-entero-pancreatic tumours Authors: Dr.
More informationSARCOPHAGINE CHELATORS AND COPPER ISOTOPES FOR IMAGING AND THERAPY
SEEING IS BELIEVING SARCOPHAGINE CHELATORS AND COPPER ISOTOPES FOR IMAGING AND THERAPY Sydney Vital and STEaM Neuroendocrine Tumour Preceptorship May 2018 Amos Hedt Head of Clinical Development 1 CLARITY
More informationNuclear Medicine in Australia. Shaun Jenkinson
Nuclear Medicine in Australia Shaun Jenkinson Landmark Infrastructure for Australian Science OPAL Research Reactor Australian Synchrotron Camperdown Cyclotron Bragg Institute Centre for Accelerator Science
More informationRodney J Hicks, MD, FRACP, FAAHMS, the Peter MaCallum Cancer Centre, Melbourne, Australia
Journal of Nuclear Medicine, published on October 6, 2016 as doi:10.2967/jnumed.116.182188 Citius, Altius, Fortius An Olympian dream for Theranostics Rodney J Hicks, MD, FRACP, FAAHMS, the Peter MaCallum
More informationPeking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China
Contrast Media & Molecular Imaging, Article ID 234389, 9 pages https://doi.org/1.1155/218/234389 Research Article Clinical and Prognostic Value of PET/CT Imaging with Combination of 68 Ga-DOTATATE and
More informationRecent Advances in Gastrointestinal Cancers
Recent Advances in Gastrointestinal Cancers Ursina R. Teitelbaum, MD Section of Hematology/Oncology Abramson Cancer Center PENN 2016 Updates in Oncology June 23, 2016 none Disclosures ASCO 2016 Highlights:
More informationTargeted Radionuclide Therapy with 90 Y-DOTATOC in Patients with Neuroendocrine Tumors
Targeted Radionuclide Therapy with 90 Y-DOTATOC in Patients with Neuroendocrine Tumors FLAVIO FORRER 1, CHRISTIAN WALDHERR 1, HELMUT R. MAECKE 2 and JAN MUELLER-BRAND 1 1 Institute of Nuclear Medicine
More informationTherapy: An introduction Prof John Buscombe
Therapy: An introduction Prof John Buscombe What is radionuclide therapy Different terms used Unsealed sources Defined for radiation protection and legal reasons Internal radiotherapy Could be confused
More informationAntiangiogenics are effective treatments in NETs
RENET: A randomized phase III trial comparing REgorafenib to placebo in patients with advanced, progressive, well-differentiated NEuroendocrine Tumors (NETs). Coordinators: Dr Julien Hadoux & Dr David
More informationPROGRAMME OVERVIEW Saturday, October 13, 2018
Saturday, October 13, 2018 Plenary Hall Meeting Room 26 Hall 1 Hall 2 Hall 3 Hall X Hall Y Hall 28 - - - - - - - - - - Advisory Council Meeting Delegates Assembly 1 Radiopharmacy/ Drug Development Trial
More informationSIRT in Neuroendocrine Tumors
SIRT in Neuroendocrine Tumors Marnix G.E.H. Lam, MD PhD Professor of Nuclear Medicine AVL Amsterdam UMC Utrecht ENETS Center of Excellence, The Netherlands Disclosure of speaker s interests Consultant
More informationCase Presentation. Marianne Ellen Pavel. Charité University Medicine Berlin. ESMO Preceptorship on GI Neuroendocrine Tumors
Case Presentation Marianne Ellen Pavel Charité University Medicine Berlin ESMO Preceptorship on GI Neuroendocrine Tumors Session 3; Singapore November 2, 2012 06.11.2012 Medical History 46-year-old man
More informationPSMA Targeted radionuclide therapy in Prostate Cancer
PSMA Targeted radionuclide therapy in Prostate Cancer Tawatchai Chaiwatanarat Division of Nuclear Medicine Department of Radiology Chulalongkorn University Bangkok, Thailand * cell si ze ~20 µm Radionuclide
More informationMolecular Imaging of NET
Molecular Imaging of NET Prof. Dr. Christophe Deroose Nuclear Medicine - University Hospitals Leuven (UZ Leuven) Department of Imaging & Pathology KU Leuven Leuven Cancer Institute (LKI) Leuven, Belgium
More informationTHERANOSTICS FOR PERSONALIZED MOLECULAR TARGETED THERAPY OF CANCER
THERANOSTICS FOR PERSONALIZED MOLECULAR TARGETED THERAPY OF CANCER Richard P. Baum Center for Molecular Radiotherapy / Department of Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik
More informationNET ΠΝΕΥΜΟΝΑ: τι νεότερο / νέες μελέτες
NETMASTERCLASS 2017: an interactive workshop NET ΠΝΕΥΜΟΝΑ: τι νεότερο / νέες μελέτες Νικόλαος Τσουκαλάς MD, MSc, PhD Ογκολόγος - Παθολόγος, MSc Βιοπληροφορική Επιμελητής Α, Ογκολογικό Τμήμα Νοσηλευτικό
More informationGEP NEN. Personalised approach. Curative and Palliative Surgery. ESMO Preceptorship Programme Neuroendocrine Neoplasms Lugano April 2018
GEP NEN Personalised approach Curative and Palliative Surgery ESMO Preceptorship Programme Neuroendocrine Neoplasms Lugano 13 14 April 2018 Professor Andrea Frilling Department of Surgery and Cancer Imperial
More informationNuclear Medicine: Basics to therapy
Nuclear Medicine: Basics to therapy RCP Medical careers day Dr Sabina Dizdarevic MD MSc PhD FRCP Dr Deena Neriman MBBS FRCR Ms Charlotte Weston CEO BNMS On behalf of the British Nuclear Medicine Society
More informationWHAT TO EXPECT IN 2015? - Renuka Iyer, MD Associate Professor of Medicine, University at Buffalo Associate Professor of Oncology, Roswell Park Cancer
WHAT TO EXPECT IN 2015? - Renuka Iyer, MD Associate Professor of Medicine, University at Buffalo Associate Professor of Oncology, Roswell Park Cancer Institute Overview Diagnosis: Gallium scan Biomarkers
More informationDosimetry in Targeted Radionuclide Therapy: The Bad Berka Dose Protocol Practical Experience
10.5005/jp-journals-10028-1058 REVIEW ARTICLE Dosimetry in Targeted Radionuclide Therapy: The Bad Berka Dose Protocol Practical Experience Christiane Schuchardt, Harshad Kulkarni, Carolin Zachert, Richard
More informationRonald C. Walker, MD, Prof of Radiology Vanderbilt University Medical Center Nashville, TN. Ga-DOTATATE PET/CT imaging Initial Vanderbilt experience
Ronald C. Walker, MD, Prof of Radiology Vanderbilt University Medical Center Nashville, TN 68 Ga-DOTATATE PET/CT imaging Initial Vanderbilt experience Disclosures: No financial disclosures or conflicts
More informationJournal of Nuclear Medicine, published on June 24, 2014 as doi: /jnumed
Journal of Nuclear Medicine, published on June 24, 2014 as doi:10.2967/jnumed.114.138834 Comparison of Somatostatin Receptor Agonist and Antagonist for Peptide Receptor Radionuclide Therapy: A Pilot Study
More informationAddison's disease Neuroendocrine tumors Paraneoplastic syndromes
Addison's disease Neuroendocrine tumors Paraneoplastic syndromes Miklós Tóth Professor of Medicine and Endocrinology 9 th April, 2018 Semmelweis University 2nd Department of Medicine Addison's disease
More informationStrategies in the Management of Neuroendocrine Tumors. Dr. Jean Maroun Dr. Elena Tsvetkova
Strategies in the Management of Neuroendocrine Tumors Dr. Jean Maroun Dr. Elena Tsvetkova 1 A ZORSE 2 Neuroendocrine Tumour Classification Neuroendocrine Tumours Carcinoid Tumours Pancreatic Neuroendocrine
More informationCRITICAL ANALYSIS OF NEN GUIDELINES. G Pentheroudakis Associate Professsor of Oncology Medical School, University of Ioannina Chair, ESMO Guidelines
CRITICAL ANALYSIS OF NEN GUIDELINES G Pentheroudakis Associate Professsor of Oncology Medical School, University of Ioannina Chair, ESMO Guidelines DISCLOSURES NO CONFLICTS OF INTEREST TO DECLARE UPDATED
More informationObjective. Assessment Question. I. Theranostics II. Classic Theranostic Agent
Up and Coming Research Radiopharmaceuticals Dao Le, Pharm.D, BCNP Director, Nuclear Medicine, Radiopharmacy University of Texas MD Anderson Cancer Center Objective I. Theranostics II. Classic Theranostic
More informationPeptide Receptor Radio-Nuclide Therapy (PRRNT) as a Novel, Rationale Option of Care for Metastatic NETs
Peptide Receptor Radio-Nuclide Therapy (PRRNT) as a Novel, Rationale Option of Care for Metastatic NETs Presented by Thomas M. O Dorisio, M.D. Professor of Medicine Director, Carcinoid & Neuroendocrine
More informationSystemic Therapy for Pheos/Paras: Somatostatin analogues, small molecules, immunotherapy and other novel approaches in the works.
Systemic Therapy for Pheos/Paras: Somatostatin analogues, small molecules, immunotherapy and other novel approaches in the works. Arturo Loaiza-Bonilla, MD, FACP Assistant Professor of Clinical Medicine
More informationClinical indications for positron emission tomography
Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will
More informationsunitinib 12.5mg, 25mg, 37.5mg, 50mg hard capsules (Sutent ) SMC No. (698/11) Pfizer Limited
sunitinib 12.5mg, 25mg, 37.5mg, 50mg hard capsules (Sutent ) SMC No. (698/11) Pfizer Limited 08 April 2011 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and
More informationChair s presentation Lutetium (177lu) oxodotreotide for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease
Public slides Chair s presentation Lutetium (177lu) oxodotreotide for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease 2 nd Appraisal Committee meeting Committee
More informationCLICK TO GO BACK TO KIOSK MENU
Clinical outcomes in patients with baseline renal dysfunction in the NETTER- Study: 77 Lu-DOTATATE vs. high dose octreotide in progressive midgut neuroendocrine tumors J. Strosberg, E. Wolin 2, B. Chasen
More informationPRESS RELEASE. Advanced Accelerator Applications Receives US FDA Approval for LUTATHERA for Treatment of Gastroenteropancreatic Neuroendocrine Tumors
PRESS RELEASE Advanced Accelerator Applications Receives US FDA Approval for LUTATHERA for Treatment of Gastroenteropancreatic Neuroendocrine Tumors First-in-class Therapy Demonstrated 79% Improvement
More informationNuevas alternativas en el manejo de TNE avanzados
Nuevas alternativas en el manejo de TNE avanzados Jaume Capdevila Hospital Universitari Vall d Hebron Barcelona Coordinación científica: Dr. Fernando Rivera Hospital Universitario Marqués de Valdecilla,
More informationTumori Neuroendocrini - Imaging perioperatorio. Annibale Versari Medicina Nucleare, Az.Osp. S.Maria Nuova-IRCCS - Reggio Emilia
Tumori Neuroendocrini - Imaging perioperatorio Annibale Versari Medicina Nucleare, Az.Osp. S.Maria Nuova-IRCCS - Reggio Emilia Imaging medico-nucleare=imaging molecolare Le immagini sono espressione delle
More informationRadioisotopes for staging and follow-up of prostate cancer. F. Scopinaro
Radioisotopes for staging and follow-up of prostate cancer F. Scopinaro Specific Radiotracers Gamma ray emitters Positron emitters 111 In capromab 111 In octreotide 99m Tc Tyr-octr. (more than one tracer)
More informationColor Codes Pathology and Genetics Medicine and Clinical Pathology Surgery Imaging
Saturday, November 5, 2005 8:30-10:30 a. m. Poorly Differentiated Endocrine Carcinomas Chairman: E. Van Cutsem, Leuven, Belgium 9:00-9:30 a. m. Working Group Sessions Pathology and Genetics Group leaders:
More informationEXOCRINE: 93% Acinar Cells Duct Cells. ENDOCRINE: 5% Alpha Cells Beta Cells Delta Cells Others
EXOCRINE: 93% Acinar Cells Duct Cells Digestive Enzymes Trypsin: Digests Proteins Lipases: Digests Fats Amylase: Digest Carbohydrates ENDOCRINE: 5% Alpha Cells Beta Cells Delta Cells Others Hormones Glucagon
More informationPANCREATIC NEUROENDOCRINE TUMORS DECEMBER 12, 2017 IF YOU EXPERIENCE TECHNICAL DIFFICULTY DURING THE PRESENTATION:
PANCREATIC NEUROENDOCRINE TUMORS DECEMBER 12, 2017 IF YOU EXPERIENCE TECHNICAL DIFFICULTY DURING THE PRESENTATION: CONTACT WEBEX TECHNICAL SUPPORT DIRECTLY AT: US TOLL FREE: 1-866-779-3239 TOLL ONLY: 1-408-435-7088
More informationPNET 3/7/2015. GI and Pancreatic NETs. The Postgraduate Course in Breast and Endocrine Surgery. Decision Tree. GI and Pancreatic NETs.
GI and Pancreatic NETs The Postgraduate Course in Breast and Endocrine Surgery Disclosures Ipsen NET Advisory Board Marines Memorial Club and Hotel San Francisco, CA Eric K Nakakura San Francisco, CA March
More informationInternational Radiation Protection Association 12 th International Congress Buenos Aires, Argentina October 19-24, Seminar I
International Radiation Protection Association 12 th International Congress Buenos Aires, Argentina October 19-24, 2008 Seminar I IRPA 12 Radiological Protection of Patient in Nuclear Medicine Ana María
More informationDiagnosing and monitoring NET
Diagnosing and monitoring NET Inaccurate or delayed diagnosis of neuroendocrine tumors (NET) is common, because many NET are small and asymptomatic. 1 When symptoms are present, they are usually nonspecific
More informationThe joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours
Eur J Nucl Med Mol Imaging (2013) 40:800 816 DOI 10.1007/s00259-012-2330-6 GUIDELINES The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine
More informationNeuroendocrine Tumors
Neuroendocrine Tumors Neuroendocrine tumors arise from cells that release a hormone in response to a signal from the nervous system. Neuro refers to the nervous system. Endocrine refers to the hormones.
More informationHepatic metastases of neuroendocrine tumors: treatment options and outcomes of local patients treated with radioembolization
Hepatic metastases of neuroendocrine tumors: treatment options and outcomes of local patients treated with radioembolization JP King PGY2 May 22, 2015 Neuroendocrine Tumor (NET) WHO Classification Location
More informationInternational Course on THERANOSTICS AND MOLECULAR RADIOTHERAPY
International Course on THERANOSTICS AND MOLECULAR RADIOTHERAPY A Joint Initiative of IAEA BELNUC - JULES BORDET INSTITUTE OCTOBER 2-6, 2017 Venue: Auditorium Tagnon Jules Bordet Institute Boulevard de
More information