Safety and Efficacy of Peptide-Receptor Radionuclide Therapy in Elderly Neuroendocrine Tumor Patients

Abstract

Peptide receptor radionuclide therapy (PRRT) is a well-established treatment in somatostatin receptor-expressing neuroendocrine tumours (NETs). The safety and efficacy of PRRT in >79 years old patients (EP) have not been systematically investigated. All patients with inoperable/metastatic/progressive G1/G2 NET, >79 years (EP), treated with PRRT at the University Hospital of Basel between 2006 and 2018, were enrolled in this retrospective matched cohort study. Each patient was manually matched with ≥1 younger patient (YP = 60–70 years). The primary endpoint was toxicity. Toxicity (subacute, long-term) was graded according to the criteria for adverse events (CTCAE) v5.0. All toxicity grades ≥ 3, or whose delta (Δ) to baseline were ≥2, were considered significant. The odds ratio (OR) for developing toxicity was tested for non-inferiority of EP vs. YP. Clinical response to PRRT and overall survival (OS) were assessed as secondary outcome measures. Forty-eight EP and 68 YP were enrolled. Both cohorts were balanced regarding median time since diagnosis, tumour location, grading, treatment scheme, and baseline biochemical parameters, except for eGFR (EP: 61 ± 16 vs. YP: 78 ± 19; mL/min/1.73 m2). Twenty-two grade ≥ 3 or Δ ≥ 2 subacute hematotoxicities occurred in 10 EP (10.3% of cycles) and 37 in 19 YP (11.6% of cycles; p = NS). Long-term grade ≥ 3 renal toxicity occurred in 7 EP and 2 YP (p = NS). The median OS was 3.4 years (EP) vs. 6.0 years (YP), HR: 1.50 [0.75, 2.98], p = NS. PRRT is a valid therapeutic option in elderly NET patients with similar toxicity and non-inferior survival compared to matched younger patients.

Predicting the survival probability of functional neuroendocrine tumors treated with peptide receptor radionuclide therapy: Serbian experience

“…In this study, we analyzed the prediction of survival in patients treated with PRRT therapy in a cohort of 51patients with welldifferentiated NETs from different sites of primary origin. According to the literature, the median age at diagnosis of NETs typically falls within the range of 61-69 years (3,(15)(16)(17)(18)(19). Consistent with these findings, our study also revealed a similar pattern, with mean age of 59.83 ± 10.83.…”

“…Specifically, it has been reported that patients over 40 years of age have an increased risk of death ( 15 – 17 ), although the clinical benefit of PRRT is satisfactory in both older and younger patients ( 16 ). In the literature, it has been shown that females tend to have better survival compared to males in the context of NETs ( 18 , 19 ). However, our study did not find a significant association between gender and survival outcomes.…”

Long-Term Complications of Radioligand Therapy with Lutetium-177 and Yttrium-90 in Patients with Neuroendocrine Neoplasms

“…in the group of 116 patients that was separated in elderly cohort (n = 48; age 81.7 ± 1,5), and younger cohort (n = 68; age 67.6 ± 1,7), we also confirmed that older age of patients is not connected with higher number of adverse events in long-term observation. This conclusions confirms the fact that RLT can be administrated in all age groups [ 16 ].…”

Radionuclide Theranostics in Neuroendocrine Neoplasms: An Update

“…PRRT was also reported to be safe in the elderly (Theiler et al described a comparable safety profile in young and elderly patients aged > 79) [ 17 ] and in patients with chronic kidney disease [ 18 ].…”