The Foundation Dedicated to Discovering a Cure for Neuroendocrine Cancer

Caring for Carcinoid Foundation

Peptide Receptor Radionuclide Therapy (PRRT)

Peptide Receptor Radionuclide Therapy (PRRT)

Most neuroendocrine tumors, including carcinoid, have five highly specialized receptors that bind to the naturally occurring hormone somatostatin.Octreotide is a synthetic analogue (a man-made version) of somatostatin that is able to attach to two of these five somatostatin receptors. 

Peptide receptor radionuclide therapy (PRRT) combines octreotide with a radionuclide (a radioactive substance) to form highly specialized molecules called radiolabeled somatostatin analogues or radiopeptides.  These radiopeptides can be injected into a patient and will travel throughout the body binding to carcinoid tumor cells that have receptors for them. Once bound, these radiopeptides emit radiation and kill the tumor cells they are bound to. 

There are three radionuclides that are attached to octreotide to create radiopeptides: indium 111 (111In), yttrium 90 (90Y) and lutetium 177 (177Lu).  These radiopeptides differ in the type of radiation they emit as well as the depth of tissue into which they penetrate.  Tissue penetration is an important factor since a certain range of radiation is necessary to kill tumor cells but not damage surrounding, healthy tissues. 111In emits both Auger electrons and γ-radiation and has the shortest range of tissue penetration (10 µm), 90Y emits β-radiation and has a range of 12 mm, and 177Lu emits both β-radiation and γ-radiation and has a range of 2 mm (Kwekkeboom, de Herder, van Eijck,  Kam, van Essen, Teunissen, Krenning, 2010).

Studies have shown that in certain individuals, the short-term results of PRRT with 177Lu and 90Y (and 111In  to a much lesser degree) are: a decrease in tumor size, a decrease in symptoms, and a halt in tumor progression (Bushnell, O’Dorisio, O’Dorisio, Menda, Hicks, Van Cutsem, Baulieu, Borson-Chazot, Anthony, Benson, Oberg, Grossman, Connolly, Bouterfa, Li, Kacena, LaFrance, & Pauwels, 2010).

Common side-effects of radiopeptide therapy are nausea, vomiting and abdominal pain.  Other less common side-effects are bone, liver and kidney toxicity, and mild hair loss. (Bushnell et al., 2010).

Individuals whose tumors can be visualized by somatostatin receptor scintigraphy (SRS) or 68 GA –DOTATE PET/CT (Haug,  Auernhammer, Wangler, Schmidt, Uebleis, Goke, Cumming, Bartenstein, Tiling, &  Hacker, 2010) and have inoperable carcinoid tumors that are growing or individuals whose symptoms are not well managed by somatostatin analogues may be candidates for PRRT. However, the extent of tumor growth, kidney function, liver function, prior treatments, and many other factors must also be considered.  (Bushnell et al., 2010; Haug et al, 2010).

For more information on peptide receptor radiotherapy please consider:

  • Video from a Carcinoid Neuroendocrine Tumor Society Singapore meeting- Neuroendocrine Tumors: Diagnosis & Treatment w/ Peptide Receptor Radiotherapy(PRRT) by Dr. Richard Baum Part 1 and Part 2.
  • CFCF Expert Interview with Dr. Baum and CFCF Director of Patient Support, Ben Blackwood.  In the interview Dr. Baum describes his experience in treating patients at the Neuroendocrine Tumor Clinic at Bad Berka where over 1,000 patients are treated annually.  Please click here to listen to this interview. 


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