Performance of 177Lu-DOTATATE-based peptide receptor radionuclide therapy in metastatic gastroenteropancreatic neuroendocrine tumor

Thapa, Pradeep; Ranade, Rohit; Ostwal, Vikas; Shrikhande, Shailesh V.; Goel, Mahesh C.; Basu, Sandip

doi:10.1097/mnm.0000000000000547

Cited by 39 publications

(23 citation statements)

References 14 publications

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“…On the contrary, 18 F-FDG PET seems to have a role in predicting disease progression, tumor response and survival in patients with advanced NETs, treated with PRRT. Most studies suggest that the patients with negative baseline scan may benefit from PRRT more than positive patients, also showing that a high 18F-FDG SUV max is associated with a poor outcome to PRRT and with disease progression [51][52][53]75]. Similar results also emerged in 22 patients with pulmonary NET, evaluated retrospectively [58].…”

Section: Discussionmentioning

confidence: 79%

“…Moreover, other studies reported the possible role of FDG PET in predicting response to PRRT, with only descriptive data. In particular, a high 18 F-FDG SUV max is associated with a poor outcome to PRRT and with disease progression [51,53,75]. This finding also emerged from a retrospective study [58] conducted on 22 patients with pulmonary NET.…”

Section: "Positive Studies"mentioning

confidence: 85%

“…Regarding 18 F-FDG PET, all studies tend to divide patients in PET-positive and PET-negative, depending on a value of SUV max 2.5 or more, as an arbitrary cut off to consider a lesion positive for malignancy (see Table 3). Among eleven papers that analyze 18 F-FDG PET, only one paper clearly defines that SUV max FDG does not have a predictive role [33], while nine papers show that this criterion could have a predictive role [2,18,51,52,55,58,64,69,75]. Finally, one paper reported descriptive data only [53].…”

Section: "Negative Studies"mentioning

confidence: 99%

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PRRT: identikit of the perfect patient

Albertelli

Dotto

Dato

et al. 2020

Rev Endocr Metab Disord

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Peptide receptor radionuclide therapy (PRRT) has been strengthened since the publication of NETTER-1. Nevertheless, the correct positioning in the therapeutic algorithm is debated, and no optimal sequence has yet been standardized. Possible criteria to predict the response to PRRT in neuroendocrine tumors (NET) have been proposed. The aim of this review is to define the perfect identity of the eligible patient who can mostly benefit from this therapy. Possible predictive criteria which have been analysed were: primary tumor site, grading, tumor burden, FDG PET and 68Ga-PET uptake. Primary tumor site and 68Ga-PET uptake do not play a pivotal role in predicting the response, while tumor burden, FDG PET uptake and grading seem to represent predictive/prognostic factors for response to PRRT. The heterogeneity in trial designs, patient populations, type of radionuclides, previous therapies and measurement of outcomes, inevitably limits the strength of our conclusions, therefore care must be taken in applying these results to clinical practice. In conclusion, the perfect patient, selected by 68Ga-PET uptake, will likely have a relatively limited liver tumor burden, a ki67 index <20% and will respond to PRRT irrespective to primary tumor. Nevertheless, we have mostly prognostic than predictive factors to predict the efficacy of PRRT in individual patients, while a promising tool could be the NETest. However, to date, the identikit of the perfect patient for PRRT is a puzzle without some pieces and still we cannot disregard a multidisciplinary discussion of the individual case to select the patients who will mostly benefit from PRRT.

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Section: Discussionmentioning

confidence: 79%

Section: "Positive Studies"mentioning

confidence: 85%

Section: "Negative Studies"mentioning

confidence: 99%

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PRRT: identikit of the perfect patient

Albertelli

Dotto

Dato

et al. 2020

Rev Endocr Metab Disord

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“…Thapa and his group [53] performed combined imaging using either [ 99m Tc]Tc-Hynic-TOC or [ 68 Ga]Ga-DOTA-TATE scans with [ 18 F]FDG in 50 patients with metastatic GEP-NEN before and after PRRT therapy with [ 177 Lu]Lu-DOTA-TATE. They found that FDG positivity, both in high and in low grade NEN, was associated with a worse response to radionuclide therapy and poor prognosis.…”

Section: Combined [68ga]ga-dota-sst Analogues and [18f]fdg Pet/ct mentioning

confidence: 99%

Role of Combined [68Ga]Ga-DOTA-SST Analogues and [18F]FDG PET/CT in the Management of GEP-NENs: A Systematic Review

Carideo

Prosperi

Panzuto

et al. 2019

JCM

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Gastro-entero-pancreatic neuroendocrine neoplasia (GEP-NENs) are rare tumors, but their frequency is increasing. Neuroendocrine tumors normally express somatostatin (SST) receptors (SSTR) on cell surface, especially G1 and G2 stage tumors, but they can show a dedifferentiation in their clinical history as they become more aggressive. Somatostatin receptor imaging has previously been performed with a gamma camera using [111In]In or [99mTc]Tc-labelled compounds, while [68Ga]Ga-labelled compounds and PET/CT imaging has recently become the gold standard for the diagnosis and management of these tumors. Moreover, in the last few years 18F-fluorodeoxyglucose ([18F]FDG) PET/CT has emerged as an important tool to define tumor aggressiveness and give relevant prognostic information, particularly when coupled with [68Ga]Ga-labelled SST analogues PET/CT. This review focuses on the importance of combined imaging with [68Ga]Ga-labelled SST analogues and [18F]FDG for the management of GEP-NENs.

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“…18 F-FDG PET/CT positivity is reported to have therapeutic value in correlating to occurrence of refractoriness to treatment with PRRT with 177 Lu DOTATATE[146]. It also correlates with shorter PFS after PRRT[147] and with shorter postoperative disease-free survival after resection of the NET[148](Table 6).…”

Section: Molecular Imaging In Pannets(table 2) (Fig 1)mentioning

confidence: 99%

Imaging of pancreatic neuroendocrine tumors: recent advances, current status, and controversies

Lee

Ito

Jensen

2018

Expert Review of Anticancer Therapy

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Recently, there have been a number of advances in imaging pancreatic neuroendocrine tumors (panNETs), as well as other neuroendocrine tumors (NETs), which have had a profound effect on the management and treatment of these patients, but in some cases are also associated with controversies. Areas covered: These advances are the result of numerous studies attempting to better define the roles of both cross-sectional imaging, endoscopic ultrasound, with or without fine-needle aspiration, and molecular imaging in both sporadic and inherited panNET syndromes; the increased attempt to develop imaging parameters that correlate with tumor classification or have prognostic value; the rapidly increasing use of molecular imaging in these tumors and the attempt to develop imaging parameters that correlate with treatment/outcome results. Each of these areas and the associated controversies are reviewed. Expert commentary: There have been numerous advances in all aspects of the imaging of panNETs, as well as other NETs, in the last few years. The advances are leading to expanded roles of imaging in the management of these patients and the results being seen in panNETs/GI-NETs with these newer techniques are already being used in more common tumors.

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Performance of 177Lu-DOTATATE-based peptide receptor radionuclide therapy in metastatic gastroenteropancreatic neuroendocrine tumor

Cited by 39 publications

References 14 publications

PRRT: identikit of the perfect patient

PRRT: identikit of the perfect patient

Role of Combined [68Ga]Ga-DOTA-SST Analogues and [18F]FDG PET/CT in the Management of GEP-NENs: A Systematic Review

Imaging of pancreatic neuroendocrine tumors: recent advances, current status, and controversies

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