PET/MR beeldvorming van de norepinephrine transporter en somatostatine receptor bij tumoren van de neurale lijst en neuro endocriene tumoren voor een betere bepaling van de radionuclide behandeling.

This project focusses on refining theranostic applications of nuclear medicine, by evaluating two new tracers for imaging the somatostatin receptor (SSTR; tracer: (Al18F-NOTA-octreotide) and the human norepinephrine transporter (hNET; tracer: 18F-MFBG). Molecular imaging of these targets is crucial for the management of patients with neuroendocrine tumors (NET) and neural crest tumors (e.g. phaeochromocytoma, paraganglioma and neuroblastoma, a type of cancer occurring most often in children). In particular, molecular imaging of these targets in metastatic disease is the gatekeeper to radionuclide therapy with beta-emitting radiopharmaceuticals aiming the SSTR (177Lu-DOTATATE) and hNET (131I-MIBG). These therapies can have a profound impact on disease progression and survival in metastatic patients. With a consortium of specialist in radiopharmacy, nuclear medicine and oncology (including paediatric oncology) from the universities of Leuven, Antwerp and Ghent, we want to demonstrate (i) the superiority of 18F-MFBG PET imaging compared to the current state of the art 123I-MIBG in patients with neural crest or NET referred for routine 123I-MIBG scanning; (ii) the equivalence of Al18F-NOTA-octreotide compared to 68Ga-DOTA-peptide PET, the current gold standard for SSTR imaging, but that is not used in many centers because they do not have access to PET or gallium-68 labelling. Both of these tracers are labelled with fluorine-18 and can be produced in large quantities, allowing several tens of patients to be scanned with one production, compared to 2-4 patients that can be scanned with gallium-68 labelled radiopharmaceuticals. These large amounts combined with the longer half-life of fluorine-18 (109 min vs. 68 minutes for gallium-68) allow centralised production and distribution to potentially any PET center in Flanders/Belgium. The goal of this project is the comparison of diagnostic accuracy and if the hypotheses of our clinical trials are demonstrated, these tracers will become the new gold standard. The final aim is implementation of these fluorine-18 labelled tracers in routine clinical care, reimbursed by the Belgian healthcare system (RIZIV/INAMI). The consortium has all the expertise necessary to achieve this aim, and has already done so for other PET tracers.