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Toxicity of high-activity 111In-Octreotide therapy in patients with disseminated neuroendocrine tumours
M E Caplin1, W Mielcarek, J R Buscombe
1Neuroendocrine Tumour Clinic, Academic Department of Medicine, Royal Free Hospital, London, UK.
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.
Insights
High-activity Indium-111 Octreotide (111In-Octreotide) shows low toxicity in treating disseminated neuroendocrine tumors. This nuclear medicine approach is well-tolerated, offering a potential therapeutic option for patients unresponsive to traditional treatments.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiopharmacology
Background:
- Disseminated neuroendocrine tumors (NETs) present significant treatment challenges, often resisting conventional radiotherapy and chemotherapy.
- Nuclear medicine's diagnostic role in NETs using radiolabeled somatostatin analogs, like 111In-Octreotide, is established.
- Emerging evidence suggests high activities of these agents may possess therapeutic potential.
Purpose of the Study:
- To evaluate the toxicity profile of high-activity 111In-Octreotide in patients with disseminated NETs.
- To explore preliminary evidence of therapeutic efficacy for this treatment modality.
Main Methods:
- Eight patients with disseminated NETs (carcinoid, medullary thyroid carcinoma, gastrinoma) received 1.3–4.6 GBq of 111In-Octreotide per administration, up to five times over 12 months.
- Comprehensive monitoring included vital signs, renal, liver, endocrine function, and hematological markers before and after treatment.
- A total of 23 administrations were analyzed for safety and tolerability.
Main Results:
- The treatment was generally well-tolerated, with minimal side effects reported, primarily transient flushing in one patient.
- Transient drops in circulating lymphocytes (4 patients) and platelets (2 patients) were observed, requiring no intervention.
- One patient with pre-existing renal impairment experienced a minor decrease in glomerular filtration rate.
Conclusions:
- High-activity 111In-Octreotide demonstrates a favorable safety profile with low toxicity in patients with disseminated neuroendocrine tumors.
- This nuclear medicine therapy is a viable option for patients with NETs refractory to standard treatments.
- Further investigations are warranted to definitively establish the therapeutic efficacy of 111In-Octreotide in NETs.