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Updated: May 22, 2025
A Whole Body Dosimetry Protocol for Peptide-Receptor Radionuclide Therapy PRRT: 2D Planar Image and Hybrid 2D+3D SPECT/CT Image Methods
Published on: April 24, 2020
Safety and Efficacy of Peptide Receptor Radionuclide Therapy in Multiple Endocrine Neoplasia Syndrome: A
Piyush Aggarwal1, Swayamjeet Satapathy1, Gurjeet Kaur2
1Departments of Nuclear Medicine.
Purpose:
Peptide receptor radionuclide therapy (PRRT) is recommended and approved in advanced neuroendocrine tumors (NETs). There is a lack of data on the utility of PRRT in multiple endocrine neoplasia (MEN) syndrome. This study explores the utility of PRRT in MEN syndrome patients with inoperable/metastatic NETs.
Methods:
A single-center retrospective analysis of MEN syndrome patients with advanced NETs referred for PRRT was done. Upto 4 cycles of 177 Lu-DOTATATE (5.5-7.4 GBq/cycle) were administered every 8-12 weeks. Treatment-related adverse events were assessed using CTCAE v5. The best response to PRRT was evaluated using RECIST 1.1. Follow-up was done to calculate the progression-free survival (PFS) and overall survival (OS).
Results:
The data of 15 patients with a median age of 36 years (IQR: 32-49) was analyzed. Fourteen patients had MEN-1 syndrome, and 1 had MEN-2 syndrome. Thirteen patients with MEN-1 syndrome had gastroenteropancreatic (GEP) NET, with the multifocal primary as the most common finding (n=7). One patient had thymic carcinoid. All patients had hyperparathyroidism, while 6 had pituitary adenoma. Fifty-three cycles of 177 Lu-DOTATATE (range: 1-4) were administered with a median cumulative activity of 27.8 GBq. Twelve patients (80%) showed grade 1/2 adverse events, with leukopenia being the most common. Six patients achieved partial response (43% ORR), 6 showed stable disease (86% DCR), 2 (14%) showed disease progression during PRRT, while 1 patient was lost to follow-up. The median PFS was 32.6 months (95% CI: 14.7-not reached) with an estimated 1- and 5-year PFS rate of 86.2% (95% CI: 68-100) and 46.3% (95% CI: 13-80), and estimated 5-year OS rate of 76.2% (95% CI: 52.1-100).
Conclusions:
177 Lu-DOTATATE is a safe and effective treatment option for advanced NETs in MEN syndrome. However, large-sized multicentric prospective studies are required.
Insights
Peptide receptor radionuclide therapy (PRRT) with 177 Lu-DOTATATE shows safety and efficacy in advanced neuroendocrine tumors (NETs) within multiple endocrine neoplasia (MEN) syndrome. This treatment offers significant progression-free and overall survival benefits for MEN syndrome patients with inoperable or metastatic NETs.
Area of Science:
- Endocrinology
- Nuclear Medicine
- Oncology
Background:
- Peptide receptor radionuclide therapy (PRRT) is a standard treatment for advanced neuroendocrine tumors (NETs).
- Limited data exists on PRRT's efficacy in patients with multiple endocrine neoplasia (MEN) syndrome.
- This study addresses the need for data on PRRT in MEN syndrome patients with advanced NETs.
Purpose of the Study:
- To explore the utility and effectiveness of PRRT in patients diagnosed with MEN syndrome and inoperable or metastatic NETs.
- To evaluate treatment response, survival rates, and adverse events associated with PRRT in this specific patient population.
Main Methods:
- A retrospective analysis was conducted on MEN syndrome patients who received PRRT.
- Patients were administered up to 4 cycles of 177 Lu-DOTATATE (5.5–7.4 GBq/cycle) every 8–12 weeks.
- Treatment response was assessed using RECIST 1.1, and adverse events were graded per CTCAE v5. Progression-free survival (PFS) and overall survival (OS) were calculated.
Main Results:
- Fifteen MEN syndrome patients (14 MEN-1, 1 MEN-2) with advanced NETs were analyzed.
- The majority (13/15) had gastroenteropancreatic (GEP) NETs; multifocal primaries were common.
- Partial response was observed in 43% (6/14) of patients, with an overall disease control rate (DCR) of 86% (12/14). Median PFS was 32.6 months, and the 5-year OS rate was 76.2%.
Conclusions:
- 177 Lu-DOTATATE PRRT is a safe and effective therapeutic option for advanced NETs in patients with MEN syndrome.
- The treatment demonstrated favorable response rates and survival outcomes in this cohort.
- Larger, prospective, multicenter studies are warranted to further validate these findings.
