Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE for Patients With Somatostatin Receptor–Expressing Neuroendocrine Tumors

Delpassand, Ebrahim S.; Samarghandi, Amin; Zamanian, Sara; Wolin, Edward M.; Hamiditabar, Mohammadali; Espenan, Gregory; Erion, Jack L.; O’Dorisio, Thomas M.; Kvols, Larry K.; Simón, Jaime; Wolfangel, Robert; Camp, A. A.; Krenning, Eric P.; Mojtahedi, Alireza

doi:10.1097/mpa.0000000000000113

Cited by 125 publications

(93 citation statements)

References 29 publications

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“…As regards the PRRT, our patient received a dosimetry-based cumulative dose of 30 GBq 177 Lu-DOTATATE without significant bone marrow and kidney toxicity at follow-up. Our results are substantially in line with those of Delpassand et al [11], indicating that treatment with multiple cycles of 177 Lu-PRRT is well tolerated up to a cumulative dose of 29.6 GBq ± 10 %. However, it is still debated whether or not PRRT can be safely used in association with 90 Y radioembolization.…”

Section: Discussionsupporting

confidence: 92%

Sequential Use of 90Y Microspheres Radioembolization and 177Lu-Dotatate in Pluri-Metastatic Neuroendocrine Tumors: A Case Report

Filippi

Ciorra

Sardella

et al. 2014

Nucl Med Mol Imaging

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90 Y radioembolization and peptide-receptor radionuclide therapy (PRRT) with 177 Lu-DOTATATE are both effective treatments for patients with inoperable neuroendocrine metastatic tumors (NET). We report the case of a 72-year-old man with severe functional syndrome due to a metastatic NET. 68 Ga-DOTATOC positron-emission tomography (PET) revealed high somatostatin receptor expression in a gross liver metastasis, in one abdominal lymph node and in several s k e l e t a l l e s i o n s . T h e p a t i e n t u n d e r w e n t l i v e r radioembolization with 90 Y-resin microspheres followed by four cycles of PRRT with 177 Lu-DOTATATE. After 3 months, a complete remission of the functional syndrome was observed. 68 Ga-DOTATOC PET demonstrated a complete response for skeletal and lymph nodal lesions with a residual bulky mass in the liver. Therefore a further 90 Y radioembolization was performed as consolidation treatment for the hepatic lesion. Six months after these combined treatments, 68 Ga-DOTATOC PET demonstrated complete metabolic response in liver and stable extrahepatic lesions. No significant long-term adverse reactions were registered. To our knowledge, the sequential use of 90 Y radiembolization before and after PRRT in a liver-dominant advanced NET has not been reported in the literature and this case suggests that these combined treatments can be safe and effective.

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Section: Discussionsupporting

confidence: 92%

Sequential Use of 90Y Microspheres Radioembolization and 177Lu-Dotatate in Pluri-Metastatic Neuroendocrine Tumors: A Case Report

Filippi

Ciorra

Sardella

et al. 2014

Nucl Med Mol Imaging

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“…However, the effect of PRRT is best evaluated in a prospective setting. Earlier studies evaluating HRQoL in patients receiving PRRT demonstrated that this treatment actually improves HRQoL in NET patients [29-31] and attenuates symptoms related to the carcinoid syndrome [30-32]. …”

Section: Discussionmentioning

confidence: 99%

Health-Related Quality of Life in Patients with Small Intestine Neuroendocrine Tumors

et al. 2018

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Background: The prevalence of small intestine neuroendocrine tumors (SI-NETs) is increasing. Disease progression is often slow and treatment options and long-term survival rates have improved, but little is known about health-related quality of life (HRQoL) in these patients. Objective: To assess HRQoL and its predictors in SI-NET patients receiving contemporary treatments. Methods: We measured HRQoL with 15D and SF-36 questionnaires in 134 SI-NET patients and compared the 15D results to those of an age- and gender-standardized sample of the general population (n = 1,153). In the patients, we studied the impact of treatments, Ki-67, liver metastases, circulating tumor markers, comorbidities, and/or socioeconomic factors on HRQoL with linear regression analysis. Results: The mean disease duration of the patients was 81 (4–468) months, 91% had metastatic disease, and 79% received somatostatin analog treatment. Hepatic tumor load was 0% in 44.8%, < 10–25% in 44.0%, and > 25% in 11.2%, respectively. Mean fP-CgA and S-5HIAA concentrations were 15 (1.3–250) and 344 (24–7,470) nmol/L, respectively. Overall, HRQoL was significantly impaired in patients compared to controls (15D score 0.864 ± 0.105 vs. 0.905 ± 0.028, p < 0.001). SI-NET patients scored worse on 9 of 15 dimensions: sleep, excretion (i.e., bladder and bowel function), depression, distress, vitality, sexual activity (p < 0.001), breathing, usual activities, and discomfort and symptoms (p < 0.01–0.05). SF-36 scores were impaired and highly correlated with 15D scores (p < 0.001). HRQoL was impaired in patients with (n = 85) compared to patients without (n = 49) impaired excretion (0.828 vs. 0.933, p < 0.001). In the patient group, number of medications predicted impaired HRQoL. Conclusions: Despite contemporary treatments, SI-NET patients have severely impaired HRQoL, including diarrhea, sleep, depression, vitality, and sexual activity.

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“…In principle, the assumption of equidistant administrations with the same activity may limit its application, but it is noted that this is the aimed pattern in the schedule by Gaze et al (2005), and also in other MRT, for instance using 177 Lu-DOTATATE (Delpassand et al, 2014) and 223 Ra-chloride (Lassmann and Nosske, 2013). Although the practical application of the BED formula has been focussed on 131 I-mIBG, it can be applied to other types of fractionated MRT.…”

Section: Discussionmentioning

confidence: 99%

Biologically effective dose in fractionated molecular radiotherapy—application to treatment of neuroblastoma with¹³¹I-mIBG

et al. 2016

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In this work, the biologically effective dose (BED) is investigated for fractionated molecular radiotherapy (MRT). A formula for the Lea–Catcheside G-factor is derived which takes the possibility of combinations of sub-lethal damage due to radiation from different administrations of activity into account. In contrast to the previous formula, the new G-factor has an explicit dependence on the time interval between administrations. The BED of tumour and liver is analysed in MRT of neuroblastoma with 131I-mIBG, following a common two-administration protocol with a mass-based activity prescription. A BED analysis is also made for modified schedules, when due to local regulations there is a maximum permitted activity for each administration. Modifications include both the simplistic approach of delivering this maximum permitted activity in each of the two administrations, and also the introduction of additional administrations while maintaining the protocol-prescribed total activity. For the cases studied with additional (i.e. more than two) administrations, BED of tumour and liver decreases at most 12% and 29%, respectively. The decrease in BED of the tumour is however modest compared to the two-administration schedule using the maximum permitted activity, where the decrease compared to the original schedule is 47%.

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Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE for Patients With Somatostatin Receptor–Expressing Neuroendocrine Tumors

Abstract: Treatment with multiple cycles of (177)Lu-DOTATATE peptide receptor radionuclide therapy is well tolerated. This treatment results in control of the disease in most patients, whereas systemic toxicities are limited and reversible. Quality of life is also improved.

Cited by 125 publications

References 29 publications

Sequential Use of 90Y Microspheres Radioembolization and 177Lu-Dotatate in Pluri-Metastatic Neuroendocrine Tumors: A Case Report

Sequential Use of 90Y Microspheres Radioembolization and 177Lu-Dotatate in Pluri-Metastatic Neuroendocrine Tumors: A Case Report

Health-Related Quality of Life in Patients with Small Intestine Neuroendocrine Tumors

Biologically effective dose in fractionated molecular radiotherapy—application to treatment of neuroblastoma with¹³¹I-mIBG

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Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE for Patients With Somatostatin Receptor–Expressing Neuroendocrine Tumors

Abstract: Treatment with multiple cycles of (177)Lu-DOTATATE peptide receptor radionuclide therapy is well tolerated. This treatment results in control of the disease in most patients, whereas systemic toxicities are limited and reversible. Quality of life is also improved.

Cited by 125 publications

References 29 publications

Sequential Use of 90Y Microspheres Radioembolization and 177Lu-Dotatate in Pluri-Metastatic Neuroendocrine Tumors: A Case Report

Sequential Use of 90Y Microspheres Radioembolization and 177Lu-Dotatate in Pluri-Metastatic Neuroendocrine Tumors: A Case Report

Health-Related Quality of Life in Patients with Small Intestine Neuroendocrine Tumors

Biologically effective dose in fractionated molecular radiotherapy—application to treatment of neuroblastoma with131I-mIBG

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Biologically effective dose in fractionated molecular radiotherapy—application to treatment of neuroblastoma with¹³¹I-mIBG