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Published on: April 17, 2019
Peptide Receptor Radionuclide Therapy as First-Line Systemic Treatment in Advanced Inoperable/Metastatic
Swayamjeet Satapathy1, Bhagwant Rai Mittal1, Ashwani Sood1
1From the Departments of Nuclear Medicine.
Purpose:
Advanced inoperable/metastatic neuroendocrine tumors (NETs) pose a therapeutic challenge with limited treatment options. Peptide receptor radionuclide therapy (PRRT), being specific in targeting the somatostatin receptors, is a promising and viable option in this setting. In this study, we intended to evaluate the role of PRRT as the first-line systemic therapy in advanced inoperable/metastatic NETs.
Methods:
Data of consecutive patients of advanced inoperable/metastatic NETs treated with first-line Lu-DOTATATE at our center, from September 2012 to August 2019, were collected and analyzed.
Results:
Forty-five patients (median age, 50 years; range, 14-72 years) with treatment-naive advanced NETs received a median cumulative dose of 27 GBq (range, 13.3-41.3 GBq; over 2-7 cycles) Lu-DOTATATE and 1250 mg/m capecitabine from days 0 to 14 of each PRRT cycle. Three patients were lost to follow-up, 2 had nonmeasurable lesions on CT, and hence, radiological response using Response Evaluation Criteria in Solid Tumors version 1.1 could be assessed in 40 patients. Twelve of 40 patients (30%) showed a partial response, whereas stable disease was observed in 22 of 40 patients (55%). Disease progression was limited to 6 of 40 patients (15%). Treatment-related adverse effects were minimal with grade 3/4 anemia, leukopenia, neutropenia, and hepatotoxicity observed in 2%, 2%, 4%, and 4% of the patients, respectively. Median progression-free survival was 48 months (95% confidence interval, 34.7-61.3 months).
Conclusions:
Our results indicate the efficacy and safety of first-line PRRT in advanced NETs. Future randomized trials, comparing PRRT and somatostatin analogs in treatment-naive patients, are required to identify the definite sequence of treatment options for these patients.
Insights
First-line peptide receptor radionuclide therapy (PRRT) with Lu-DOTATATE demonstrated efficacy and safety in advanced neuroendocrine tumors (NETs). This treatment offers a promising option for patients with inoperable or metastatic NETs, showing significant progression-free survival.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiopharmaceutical Therapy
Background:
- Advanced inoperable/metastatic neuroendocrine tumors (NETs) present significant therapeutic challenges.
- Limited treatment options exist for advanced NETs, necessitating novel therapeutic strategies.
- Peptide receptor radionuclide therapy (PRRT) targets somatostatin receptors, offering a specific approach for NETs.
Purpose of the Study:
- To evaluate the efficacy and safety of PRRT as a first-line systemic therapy for advanced inoperable/metastatic NETs.
- To assess the treatment response and progression-free survival in NET patients receiving first-line PRRT.
Main Methods:
- Retrospective analysis of consecutive patients with advanced inoperable/metastatic NETs treated with first-line Lu-DOTATATE and capecitabine.
- Treatment involved Lu-DOTATATE cycles combined with capecitabine over a defined period.
- Radiological response was assessed using Response Evaluation Criteria in Solid Tumors version 1.1.
Main Results:
- A partial response was observed in 30% of patients, with 55% achieving stable disease.
- Disease progression was noted in only 15% of patients, indicating significant disease control.
- Treatment-related adverse effects were minimal, with low rates of grade 3/4 hematological and hepatic toxicity.
Conclusions:
- First-line PRRT with Lu-DOTATATE is an effective and safe treatment option for advanced NETs.
- The study highlights a median progression-free survival of 48 months.
- Further randomized trials comparing PRRT with somatostatin analogs are needed to establish optimal treatment sequencing.
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