Peptide receptor radionuclide therapy (PRRT) has significantly advanced in the last two decades within the realm of neuroendocrine tumours (NETs), leveraging the overexpression of somatostatin receptors characteristic of these tumours. This same receptor profile is also prevalent in nearly all meningiomas, with expression of somatostatin receptor 1 & 2 (SSTR1 / SSTR2), rendering PRRT a viable treatment option. Multiple studies have scrutinized the efficacy of PRRT (¹⁷⁷Lu-DOTATATE) in meningioma patients, consistently demonstrating its effectiveness, particularly in prolonging progression-free survival (PFS).

The principal advantage of PRRT over conventional external beam radiotherapy lies in its molecular precision targeting meningioma cells, facilitating the management of multicentric lesions within a single session. Moreover, given the intricate nature of the brain, where critical structures tightly envelop tumours, accurate tumour targeting with minimal radiation exposure to healthy brain tissue becomes paramount to mitigate adverse effects.

These same receptors obviously offer an ideal diagnostic target. Studies have revealed the superiority of ⁶⁸Ga-DOTATATE over conventional brain imaging modalities such as MRI. Its heightened sensitivity enhances pre-, intra-, and postoperative evaluations by excelling in discerning bony or skull involvement and distinguishing unresectable optic nerve sheath meningiomas. Consequently, this imaging modality significantly informs therapeutic decision-making, thereby optimizing disease management. Indeed, the Response Assessment in Neuro-Oncology (RANO) guidelines now endorse the integration of ⁶⁸Ga-DOTATATE PET imaging for meningioma patients.

We invite you to join us at the forthcoming symposium of the Nuclear Medicine & Neurooncology Society in Vienna on April 26 – 27, dedicated to "Diagnostic & Therapeutic Innovations in the Era of Precision Medicine," where we will delve into the application of radioligand therapies in treating meningiomas. Secure your participation by registering now.

Literature:

⁶⁸Ga-DOTATATE PET: The Future of Meningioma Treatment. Prasad RN, Perlow HK, Bovi J, Braunstein SE, Ivanidze J, Kalapurakal JA, Kleefisch C, Knisely JPS, Mehta MP, Prevedello DM, Raleigh DR, Mishra MV, Roberge D, Rogers CL, Palmer JD.  Int J Radiat Oncol Biol Phys. 2022 Jul 15;113(4):868-871. doi: 10.1016/j.ijrobp.2022.04.041. PMID: 35772444.

Somatostatin Receptor Theranostics for Refractory Meningiomas. Salgues, B.; Graillon, T.; Horowitz, T.; Chinot, O.; Padovani, L.; Taïeb, D.; Guedj, E. Curr. Oncol. 2022, 29, 5550-5565. doi: 10.3390/curroncol29080438

Intraarterial Administration Boosts ¹⁷⁷Lu-HA-DOTATATE Accumulation in Salvage Meningioma Patients. Evert-Jan P.A. Vonken, Rutger C.G. Bruijnen, Tom J. Snijders, Tatjana Seute, Marnix G.E.H. Lam, Bart de Keizer, Arthur J.A.T. Braat. Journal of Nuclear Medicine Mar 2022, 63 (3) 406-409; DOI: 10.2967/jnumed.121.262491

Efficacy of ¹⁷⁷Lu-Dotatate Therapy in the Treatment of Recurrent Meningioma. Zahid A, Johnson DR, Kizilbash SH. Mayo Clin Proc Innov Qual Outcomes. 2021 Jan 14;5(1):236-240. doi: 10.1016/j.mayocpiqo.2020.09.015. PMID: 33718799; PMCID: PMC7930777.