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Yttrium-90 DOTATOC: first clinical results.
A Otte1, R Herrmann, A Heppeler
1Department of Nuclear Medicine, University Hospital, School of Medicine, CH-4031 Basel, Switzerland.
European Journal of Nuclear Medicine
|November 7, 1999
Summary
Yttrium-90 DOTA-d-Phe(1)-Tyr(3)-octreotide (90Y-DOTATOC) shows therapeutic potential for advanced somatostatin receptor-positive tumors. Further research is needed to address and resolve toxicity issues for broader clinical application.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiopharmaceutical Therapy
Background:
- Advanced somatostatin receptor-positive tumors often lack other treatment options.
- DOTA-d-Phe(1)-Tyr(3)-octreotide (DOTATOC) labeled with yttrium-90 ((90)Y-DOTATOC) is a potential therapeutic agent.
- Pilot studies indicated its use in patients with limited therapeutic alternatives.
Purpose of the Study:
- To evaluate the therapeutic potential of (90)Y-DOTATOC in a larger patient cohort.
- To establish a standardized treatment protocol for (90)Y-DOTATOC therapy.
- To assess and monitor potential side effects, particularly renal and hematological toxicity.
Main Methods:
- A cohort of 29 patients with advanced somatostatin receptor-positive tumors received four or more doses of (90)Y-DOTATOC.
- An intra-patient dose escalation study was conducted with ascending activity at approximately 6-week intervals.
- Treatment monitoring included computed tomography, indium-111 DOTATOC scintigraphy, weekly blood parameter checks, and 6-weekly tumor marker and liver enzyme controls.
- Renal toxicity was managed with Hartmann-Hepa 8% solution in some patients.
Main Results:
- Twenty-four out of 29 patients experienced no severe renal or hematological toxicity (<= grade 2) with cumulative doses up to 7400 MBq/m(2).
- Five patients developed renal and/or hematological toxicity (cumulative dose >7400 MBq/m(2)), with four experiencing renal toxicity (two requiring hemodialysis).
- Disease stabilization was observed in 20 patients, partial remission in two, tumor mass reduction (<50%) in four, and progression in three.
Conclusions:
- (90)Y-DOTATOC demonstrates significant therapeutic promise as an anti-cancer agent, particularly for advanced somatostatin receptor-positive tumors.
- Toxicity, specifically renal and hematological, remains a challenge that requires further investigation and mitigation strategies.
- Ongoing evaluation of amino acid infusions, such as Hartmann-Hepa 8% solution, aims to reduce renal toxicity during (90)Y-DOTATOC treatment.