Somatostatin Receptor Theranostics for Refractory Meningiomas

Area of Science:

• Oncology
• Nuclear Medicine
• Neurosurgery

Background:

• Meningiomas are tumors arising from the meninges.
• Treatment-refractory meningiomas pose a significant clinical challenge, often progressing after surgery and radiotherapy.
• Somatostatin receptor (SSTR)-targeted peptide receptor radionuclide therapy (PRRT) is an emerging treatment modality.

Purpose of the Study:

• To evaluate the outcomes of patients with refractory meningiomas treated with 177Lu-DOTATATE.
• To conduct an overall analysis of progression-free survival at 6 months (PFS-6) from relevant literature for SSTR-targeted PRRT in meningioma.

Main Methods:

• Retrospective analysis of eight patients with recurrent and progressive WHO grade II meningiomas treated with 177Lu-DOTATATE between 2019 and 2022.
• Comparison of PFS-6 from the case series with aggregated data from 86 patients in previous studies treated with 177Lu-DOTATATE or 90Y-DOTATOC.

Main Results:

• The case series demonstrated a PFS-6 of 85.7% for WHO grade II progressive refractory meningiomas.
• Overall analysis of literature showed PFS-6 of 89.7% for WHO grade I, 57.1% for WHO grade II, and 0% for WHO grade III meningiomas.
• SSTR-targeted PRRT was well tolerated, with prolonged PFS-6 observed in WHO grade I and II meningiomas, excluding aggressive WHO grade II subtypes.

Conclusions:

• SSTR-targeted PRRT is a viable option for managing progressive, refractory meningiomas, particularly WHO grade I and II.
• The efficacy of PRRT varies by tumor grade, with less benefit in aggressive subtypes.
• Further large-scale randomized trials are necessary to establish PRRT within clinical practice guidelines for refractory meningioma.