Neuroendocrine tumours: from radioligands to immunotherapy the cure is closer

The marked and continuous improvement in diagnostic techniques makes it easier to detect incidental tumours: the most common sites are the gastroenteropancreatic tract, then the stomach, intestine, pancreas, appendix and lungs. Neuroendocrine tumours are rare neoplasms, with an increasing incidence of 5-6 cases per 100,000 inhabitants per year in Italia and about 25 per million in Europe. Predominantly gastroenteropancreatic or pulmonary, they often affect people over 60-65 years of age. In Italia, there are an estimated 2,700 new cases each year.

Their incidence is on the rise and the issue was the focus of the recent European Neuroendocrine Tumour Society (ENETS) Congress in Krakow, which was specifically dedicated to the introduction of new drugs for the treatment of high-grade neuroendocrine neoplasms.

The term 'neuroendocrine neoplasms' (Nen) includes both the group more commonly referred to as 'neuroendocrine tumours' (Net), which are more numerous and have a more favourable prognosis, and 'neuroendocrine carcinomas' (Nec), which are less frequent and have a poor prognosis. Nen are a group of neoplasms that are relatively rare in absolute numbers, but are particularly heterogeneous and can develop in many different organs or apparatuses.

Returning from the Krakow Congress, where he was elected to the ENETS Presidency for the two-year period 2026-2028, Nicola Fazio - Director of the Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours and Director of the Digestive and Neuroendocrine Tumours Programme at the European Institute of Oncology in Milan - explains that among the most exciting aspects to emerge from the proceedings is the fact that "new drugs are starting to arrive in the field of Nec, for which chemotherapy is currently the only therapeutic option, with poor results. Promising results in terms of efficacy and tolerance were presented in Cracow for Obrixtamig, a bispecific antibody belonging to the category of so-called T-cell engagers: its mechanism of action is innovative: on the one hand it binds to the DLL3 protein present on tumour cells, and on the other to the CD3 expressed on T lymphocytes, thus activating the immune system and directing it against the tumour. It is, in effect, a form of immunotherapy. Data from phase I and II studies have shown encouraging results in terms of both efficacy and tolerability'.

'Another important novelty that has emerged,' according to the professor, 'is that of alpha-emitters, a new form of radiopharmaceuticals (also called radioligands) that appears to be more effective than beta-emitters, radiopharmaceuticals already approved for NETs of the digestive tract. This is a form of precision therapy, in essence an ultra-targeted systemic radiotherapy on somatostatin receptors, the expression of which must be detected by PET with gallium68'.