La radioligand therapy (RLT) nei tumori neuroendocrini

Neuroendocrine tumours (NETs) are a group of heterogeneous neoplasms, often diagnosed at an advanced stage of disease. The results of the NETTER-1 study paved the way for the approval of radioligand therapy (RLT) by EMA, FDA, and, in 2019, AIFA. Ever since, RLT has become a mainstay in the treatment of locally advanced or metastatic well-differentiated (G1 and G2) gastro-entero-pancreatic NETs (GEP-NETs), progressive to the first-line treatment with “cold” somatostatin analogues. Although the efficacy and safety of RLT in NETs has been extensively demonstrated in the literature, some open questions remain. Among them, the main ones are the definition of the best timing compared with other therapies and the extension of the treatment to “RLT orphan” neoplasms. At the same time, the development of new radiopharmaceutical strategies that aim at improving the theragnostic model currently in use are being investigated. The aim of this work is to describe the milestones that led to the approval of RLT in GEP-NETs and to discuss current challenges and future perspectives of this therapeutic approach.