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Based on the results of the NETTER-1 trial, peptide receptor radionuclide therapy with Lutetium-177 (177Lu) – DOTATATE is authorized for the treatment of neuroendocrine tumors (NET) grade 1 (G1) and grade 2 (G2) of the intestine. After the failure of 177Lu-DOTATATE therapy, targeted alpha-particle therapy (TAT) may be a possible treatment option. Here, we present a patient with cancer of unknown primary NET G2 later G3. The patient was referred to our hospital with urosepsis due to a second-degree urinary retention. After stent insertion, a contrast-enhanced computed tomography revealed a huge pelvic tumor without metastases. Initially, the patient had undergone surgical treatment. Later the patient developed liver metastasis and was treated by 177Lu-DOTATATE therapy and four lines of systemic therapy. A disease progression was observed and with the knowledge of a germline BRCA1 mutation, the patient was treated with TAT (Actinium-225 [225Ac]-DOTATATE) combined with olaparib. The patient achieved a significant treatment response for 12 months indicating that a combination therapy with an alpha emitter and olaparib demands further investigations in clinical trials.

Three different power-to-methane process chains with grid injection in two scales (1 MWel and 6 MWel) were analysed regarding their investment and operation cost. The process chains were based on biological or catalytic bubbling fluidised bed methanation in combination with proton exchange membrane or solid oxide electrolyser cells. A bottom-up techno-economic analysis showed a cost benefit of around 17–19% lower biomethane production cost for the bubbling fluidised bed technology as less than a third of the reactor volumes is required for catalytic methanation. This cost benefit is only given in combination with PEM electrolysis, as the high-temperature electrolyser stacks currently result in high investment cost. Based on electricity cost of 5 €-ct/kWhel and a plant size of 6 MWel, biomethane production cost of 13.95 €-ct./kWh for catalytic and 17.30 €-ct/kWh for biological methanation could be obtained, both including PEM electrolysis. A significant efficiency increase by integrating the heat of catalytic methanation reaction with the high-temperature electrolysis can be achieved; however investment cost have to decrease below 1000 €/kWel to obtain economically feasible production cost of biomethane. Under current economic and technological circumstances, CO2 methanation using the bubbling fluidised bed technology is the most cost effective.

Background and AimsNeuroendocrine neoplasms (NENs) of the presacral space are an extremely rare disease entity with largely unknown outcome and no established standard of care treatment. Therefore, we wanted to analyze clinical presentation, histopathological findings, treatment outcomes, and prognosis in a multicentric patient cohort.MethodsWe searched local databases of six German NEN centers for patients with presacral NEN. Retrospective descriptive analyses of age, sex, stage at diagnosis, symptoms, grade, immunohistochemical investigations, biomarkers, treatment, and treatment outcome were performed. Kaplan–Meier analysis was used to determine median overall survival.ResultsWe identified 17 patients (11 female, 6 male) with a median age of 50 years (range, 35–66) at diagnosis. Twelve cases presented initially with distant metastases including bone metastases in nine cases. On pathological review the majority of patients had well-differentiated G2 tumors. Immunohistochemical profile resembled rectal NENs. All but one patient had non-functioning tumors. Somatostatin receptor imaging was positive in 14 of 15 investigated cases. Eight patients were treated surgically including palliative resections; 14 patients received somatostatin analogs with limited efficacy. With 14 PRRTs completed, 79% showed clinical benefit, whereas only one patient with neuroendocrine carcinoma (NEC) responded to chemotherapy. Treatment with everolimus in three patients was not successful, whereas cabozantinib resulted in a disease stabilization in a heavily pretreated patient. During a median observation period of 44.5 months, 6 patients died. Median overall survival was not reached.ConclusionPresacral NEN are histopathologically similar to rectal NENs. Presacral NEN should be considered as possible primary in NEN of unknown primary. The majority of tumors is non-functioning and somatostatin receptor positive. PRRT demonstrated promising activity; tyrosine kinase inhibitors warrant further investigations. Further molecular characterization and prospective evaluation of this rare tumor entity are needed.

Palladium supported on zeolite is a highly active catalyst for complete methane oxidation, but its stability needs to be improved. Here, the authors design a highly active catalyst resistant to steam-induced sintering under reaction conditions by alleviating the high mobility of palladium nanoparticles and zeolite degradation.