Toxicity of high-activity 111In-Octreotide therapy in patients with disseminated neuroendocrine tumours

Abstract

Disseminated neuroendocrine tumours are difficult to treat and are generally not responsive to radiotherapy or chemotherapy. Nuclear medicine techniques using a radiolabelled somatostatin analogue, 111In-Octreotide, have been used for the diagnosis of neuroendocrine tumours. It has been suggested that high activities of such an agent may have a therapeutic effect. The aims of this study were to assess toxicity and to determine if there had been evidence of efficacy. Eight patients with known disseminated neuroendocrine tumours were enrolled in the study; six had carcinoid tumours, one had a medullary cell carcinoma of the thyroid and one patient had a malignant gastrinoma. Between 1.3 and 4.6 GBq of 111In-Octreotide were administered to each patient for up to five administrations over 12 months. A total of 23 administrations were given. Tests of vital signs, renal, liver and endocrine function as well as haematological markers were taken before and after treatment. The treatment was well tolerated with only one patient suffering from a sensation of flushing during the infusion but no changes in vital sings. There was a transient (up to 48 h) drop in circulating lymphocytes in four patients and platelets in two patients; no supportive therapy was needed. One patient with severe renal impairment had a slight reduction in glomerular filtration rate. We conclude that high-activity 111In-Octreotide is well tolerated with low toxicity and can be considered for use in patients with disseminated neuroendocrine tumours. Further work is now being performed to assess efficacy.

Long-term efficacy of low activity meta-[131I]iodobenzylguanidine therapy in patients with disseminated neuroendocrine tumours depends on initial response

“…Though higher activity 131 I-MIBG has been reported to have toxicity in some patients most of these have been in patients with neuroblastoma, who tend to be co-treated with chemotherapy and have bone metastasis. In fact like other treatments for neuroendocrine tumours such as high activity 111 In pentetreotide [19], this treatment is safe and generally efficacious.…”

Functional imaging of malignant paragangliomas and carcinoid tumours

“…The inability to localise all tumour sites also has implications for therapy with 131 I-MIBG, 111 In-[D-Phe 1 ]-DTPA-octreotide and 90 Y-DOTATOC [10,11,12]. Individually, or in combination, these radiopharmaceuticals will not achieve total tumour kill.…”

Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours

“…150 151 Treatment is well tolerated and toxicity limited to temporary myelosuppression 4-6 weeks post therapy. 152 This will be more severe in patients who have bone marrow infiltration by tumour at the time of treatment or who have undergone previous chemotherapy or targeted therapy. Myelosuppression is cumulative and may be dose limiting after repeated treatment cycles.…”