Peptide receptor radionuclide therapy (PRRT) in radioiodine-refractory thyroid cancer: A case report of significant response to lu177 DOTA-TATE treatment

Abstract

A 59-year-old woman with follicular thyroid carcinoma underwent total thyroidectomy followed by radioiodine treatment. Following treatment, the whole-body scan did not show any abnormal radioiodine uptake. However, during the follow-up, the serum thyroglobulin (Tg) value increased without detectable thyroglobulin-antibodies. We performed a Ga-68 DOTA-TATE PET/CT showing a sternal lesion and several lung nodules with high somatostatin receptor density. Also, on the next day, FDG PET/CT was performed, which confirmed the findings. Considering the high levels of somatostatin receptor expression in such metastases, we planned lu177 DOTA-TATE therapy. After two cycles of lu177 DOTA-TATE injection, serum thyroglobulin significantly dropped, and she claimed that her sternal pain and dyspnea were much better. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin-receptor expression, treated with 177Lu-DOTA-TATE, showing a significant response.

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

“…Disease relapse in terms of sternal and lung metastases that were iodine-refractory were further detected. Upon exam, they the metastases were determined to be highly positive in somatostatin receptors; thus, PRRT was offered to the patient, and she achieved a thyroglobulin decrease, in addition to an improvement of the sternal pain and respiratory complaints [ 43 ]. Currently, PRRT (such as 68Ga/177Lu-DOTATATE) represents an important chapter in the management of iodine-refractory differentiated thyroid malignancies in addition to C cells derivate medullary thyroid cancer (as part of the larger frame, with respect to the neuroendocrine neoplasia); thus, we highlight the importance of determining the somatostatin receptors’ status through Octreoscan and/or immunohistochemistry (if feasible) in radioiodine negative differentiated thyroid carcinomas [ 44 , 45 ].…”

“…Overall, we identified 14 studies (of more than 1 subject/article) [ 18 , 20 , 21 , 22 , 24 , 51 , 53 , 64 , 66 , 70 , 72 , 73 , 74 , 75 ] and 34 single case reports [ 14 , 15 , 16 , 17 , 19 , 23 , 25 , 26 , 38 , 41 , 42 , 43 , 47 , 52 , 55 , 56 , 59 , 60 , 62 , 68 , 71 , 76 , 77 , 78 , 89 , 98 , 99 , 100 , 101 , 102 ] within our methods with respect to sternal metastases (n = 48 papers) ( Table 5 ).…”

“… Overview of published case reports (N = 34) according to our methods [ 14 , 15 , 16 , 17 , 19 , 23 , 25 , 26 , 30 , 32 , 33 , 37 , 38 , 41 , 42 , 43 , 47 , 52 , 55 , 56 , 59 , 60 , 62 , 68 , 71 , 76 , 77 , 78 , 89 , 98 , 99 , 100 , 101 , 102 ]. Abbreviations: N = number of patients; MiNEN = mixed neuroendocrine–non-neuroendocrine tumour.…”

“…Table 5. Single case reports of sternal metastases according to our methods; the articles are cited starting with the most recent time of publication [14][15][16][17]19,23,25,26,30,32,33,37,38,[41][42][43]47,52,55,56,59,60,62,68,71,[76][77][78]89,[98][99][100][101][102]. The case we mentioned brought up the importance of addressing a sternal biopsy into the larger frame of multi-lined, complex management.…”

Lutathera® Orphans: State of the Art and Future Application of Radioligand Therapy with 177Lu-DOTATATE

“…Potential use of [ 177 Lu]Lu-DOTATATE in rare tumors is currently minimally explored, and there are only a few studies on restricted groups of patients. Moreover, several case reports tested [ 177 Lu]Lu-DOTATATE for other malignancies, such as recurrent skull base phosphaturic mesenchymal tumor [83], mantle cell lymphoma [84], radioiodine refractory thyroid cancer [85], sarcoma [86], and breast cancer [87].…”