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Peptide receptor radionuclide therapy for aggressive atypical pituitary adenoma/carcinoma: variable clinical response
Jillian Maclean1, Matthew Aldridge, Jamshed Bomanji
1University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK, jillianmaclean@nhs.net.
Purpose:
There are limited treatment options for progressive atypical pituitary adenomas and carcinomas. Peptide receptor radionuclide therapy that targets somatostatin receptors has recently been proposed as a potential treatment option. The theoretical rationale for efficacy is elegant but evaluation of outcomes in the first patients treated for this indication is required to assess whether further study is warranted.
Methods:
We performed a case review of the three pituitary patients we have treated with (177)Lutetium DOTATATE in our institution (two atypical adenomas, one carcinoma) and dosimetric analysis of the radiation uptake in one patient.
Results:
Treatment was well tolerated. One patient with slowly progressive pituitary carcinoma has stable disease 40 months after completing the planned 4 cycles of treatment. Two patients with rapidly progressive atypical adenomas terminated treatment early due to continued disease progression. Dosimetric evaluation revealed inhomogenous uptake across the tumour (1.3-11.9 Gy with one cycle).
Conclusion:
We have found mixed results in our first 3 patients with stable disease achieved only in the patient with the more slowly progressive tumour. As only a limited number of centres offer Peptide receptor radionuclide therapy, a formal study with prospective data collection may be feasible and if carried out should include dosimetric evaluation of absorbed dose.
Insights
Peptide receptor radionuclide therapy shows mixed results for aggressive pituitary tumors. Stable disease was seen in one slow-progressing carcinoma patient, but not in those with rapidly progressing atypical adenomas.
Area of Science:
- Endocrinology
- Oncology
- Nuclear Medicine
Background:
- Limited effective treatments exist for progressive atypical pituitary adenomas and carcinomas.
- Peptide receptor radionuclide therapy (PRRT) targeting somatostatin receptors is a novel therapeutic approach.
Purpose of the Study:
- To evaluate the outcomes of PRRT in patients with atypical pituitary adenomas and carcinomas.
- To assess the safety and efficacy of (177)Lutetium DOTATATE for these rare pituitary tumors.
Main Methods:
- A case review of three pituitary patients treated with (177)Lutetium DOTATATE.
- Included two patients with atypical adenomas and one with carcinoma.
- Dosimetric analysis of radiation uptake was performed in one patient.
Main Results:
- Treatment was generally well tolerated.
- One patient with pituitary carcinoma achieved stable disease for 40 months.
- Two patients with atypical adenomas experienced continued progression and terminated treatment early.
- Dosimetric evaluation showed heterogeneous tumor uptake (1.3-11.9 Gy per cycle).
Conclusions:
- PRRT yielded mixed results, with benefit observed only in the slowly progressive carcinoma case.
- Further prospective studies with dosimetric evaluation are warranted to confirm efficacy and guide treatment.
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