Peptide Receptor Radionuclide Therapy in Patients With Differentiated Thyroid Cancer

Abstract

Purpose As patients with progressive medullary thyroid cancer (MTC) and radioiodine-refractory metastatic differentiated nonmedullary thyroid cancer (DTC) have poor prognoses and present therapeutic challenges, peptide receptor radionuclide therapy (PRRT) targeting the somatostatin receptor provides a promising option. This meta-analysis evaluated the therapeutic effects and outcomes of PRRT in differentiated thyroid cancer. PATIENTS AND METHODS PUBMED, EMBASE, CINAHL, SCOPUS, and COCHRANE were systematically searched using appropriate key words. The primary therapeutic effect was the radiological response after PRRT, and the objective response rate (ORR) and disease control rate (DCR) were identified in MTC and DTC, respectively. The outcome of serious adverse events (grade 3 or 4), additional therapeutic effects of 18F-FDG PET/CT and biochemical (calcitonin and thyroglobulin) responses, and radionuclides for PRRT were assessed as subgroup analyses. The parameters were generated as pooled proportions. Results Eleven articles with 165 patients were included (98 patients with MTC and 67 patients with DTC). PRRT achieved pooled proportions of ORR in 8.53% to 15.61%, DCR in 53.95% to 59.99%, and serious adverse events in 2.79% to 2.82% in MTC and DTC patients. 18F-FDG PET/CT and biochemical responses revealed similar results as the radiological response. 177Lu-based PRRT (ORR, 11.48%–24.52%; DCR, 61.47%–67.26%) showed better therapeutic effects than 90Y-based PRRT (ORR, 6.98%–13.82%; DCR, 50.86%–57.29%). Conclusions This meta-analysis suggests that PRRT could be a potential and safe strategy for MTC and DTC. In particular, PRRT with 177Lu exhibited improved therapeutic effects relative to PRRT with 90Y.

Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis

“… 73 These early data suggest that PRRT may be considered in selected patients with advanced, progressive, or metastatic MTC in the context of a clinical trial. 72 , 73 …”

“…The pooled proportion of patients with disease control in MTC was nearly 60% with serious adverse events occurring in 2.79%. 73 These early data suggest that PRRT may be considered in selected patients with advanced, progressive, or metastatic MTC in the context of a clinical trial. 75 This is particularly relevant for patients with Stage-III or -IV disease who have an excellent response to initial therapy.…”

Peptide Receptor Radionuclide Therapy in Thyroid Cancer

“…A meta-analysis by Lee et al. evaluated 11 published articles on DTC and/or MTC for efficacy and outcomes with various PRRTs ( 123 ). The objective response rate (ORR) in MTC was 8.5% (95% CI, 1.9% – 19.2%; i 2 = 53.5%) and the disease control rate (DCR) was 60% (95% CI, 49.6%–69.8%; i 2 = 28.7%), while for DTC, the ORR and DCR rates were 15.6% (95% CI, 7.80%–26.74%; i 2 = 0%), and 53.9% (95% CI: 41.13%–66.39%; i 2 = 0%), respectively.…”

Positron Emission Tomography Radiopharmaceuticals in Differentiated Thyroid Cancer

“…A meta-analysis study evaluated the therapeutic effect of PRRT in 67 RAI-refractory DTC patients and reported pooled proportions of objective response rate of 15.61%, disease control rate of 53.95%, and serious adverse events of 2.83%. Moreover, PRRT with 177 Lu had a relatively better therapeutic effect than PRRT with 90 Y [ 70 ]. PRRT may become an alternative treatment for recurrent or metastatic RAI-refractory DTC patients with adequate SSTR expression.…”