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131I-MIBG + 90Y-DOTATOC is a combination radiopharmaceutical therapy investigated for the treatment of advanced neuroendocrine tumors, including midgut neuroendocrine tumors, pheochromocytoma, and paraganglioma. This dual-radionuclide approach, developed by Dr. David Bushnell at the University of Iowa, combines two distinct targeting mechanisms: 131I-MIBG (iodine-131 metaiodobenzylguanidine), which is taken up by the norepinephrine transporter system in neuroendocrine cells, and 90Y-DOTATOC (yttrium-90 DOTA-Phe1-Tyr3-octreotide), which binds to somatostatin receptors (SSTR). By utilizing patient-specific dosimetry, the therapy aims to maximize the radiation dose delivered to tumor tissues while minimizing toxic exposure to critical organs such as the kidneys and bone marrow. The combination has demonstrated the potential to significantly increase tumor radiation doses compared to single-agent peptide receptor radionuclide therapy (PRRT).
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