Teranostika i precizna medicina u neuroendokrinim tumorima
Sažetak
Uvod. Neuroendokrini tumori (NET) imaju povećanu ekspresiju somatostatinskih receptora (SSTR), pri čemu su najčešći podtipovi 2 i 5. Prekomerna ekspresija SSTR-a je izvanredna molekularna meta za neoperabilne i metastatske NET-ove koja omogućava jedinstven pristup ciljanoj dijagnostici i terapiji. Pored SSTR, neuroendokrini tumori eksprimiraju i druge receptore koji mogu biti pogodne mete za vizuelizaciju metodama nuklearne medicine.
Cilj. Ovaj pregledni rad je fokusiran na najčešće radiofarmaceutike i njihove molekularne mete koje se danas koriste na osnovu teranostičkog pristupa u NET.
Rezultati. U konvencionalnoj nuklearnoj medicini najvažniji dijagnostički radiofarmaceutici su analozi somatostatina (SSA) obeleženi 111In i 99mTc, međutim 99mTc ima prednost u odnosu na 111In na osnovu boljih fizičkih karakteristika i lakšeg izvođenja. Poslednjih godina stvoreni su veoma moćni teranostički parovi za snimanje i lečenje NET-ova, koji se mogu snažno vezati za SSTR. Derivati 68Ga obeleženih oktreotidom se preporučuju za dijagnostiku i praćenje NET-a. Velika prednost 68Ga radiofarmaceutika je u tome što se identična jedinjenja mogu obeležiti terapeutskim radionuklidima 90Y i 177Lu.
Zaključak. Radionuklidna terapija usmerena na peptidne receptore je sistemska molekularna ciljna terapija koja se pokazala bezbednom i veoma efikasnom u kontroli bolesti i dužem preživljavanju pacijenata sa uznapredovalim i neoperabilnim NET. Uz zanemarljiv broj neželjenih efekata, ova terapija je bezbedna i treba je primeniti kod svih pacijenata koji ispunjavaju neophodne kriterijume, pre svega prekomernu ekspresiju SSTR tipa 2.
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