Efficacy and safety of peptide receptor radionuclide therapy in advanced radioiodine-refractory differentiated thyroid cancer and metastatic medullary thyroid cancer: a systematic review

Abstract

Background It has been shown that a subgroup of patients with differentiated thyroid cancer (DTC) and medullary thyroid carcinoma (MTC) would progress to advanced stages of thyroid cancer. Therefore, the present study was done to systematically review available evidence in order to investigate efficacy and safety of peptide receptor radionuclide therapy (PRRT) in the patients with advanced radioiodine refractory differentiated thyroid cancer (RR-DTC) and metastatic MTC. Methods For this purpose, relevant studies investigated safety and efficacy of PRRT in the patients with advanced RR-DTC and metastatic MTC were identified by searching Medline (Pubmed, Ovid, and Ebsco), Scopus, Embase, Web of Science, and Cochrane Library databases (from database inception to March 24, 2021). The review was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Searching was done independently by two investigators. Two researchers independently extracted the data and any disagreement was adjudicated by consensus. Quality of the studies was assessed using the tool of case reports/series in systematic reviews. Results Among 2284 related papers, 41 papers met the inclusion criteria. A total of 157 patients with RR-DTC were treated with PPRT. Biochemical and objective responses (partial and complete) were observed in 25.3 and 10.5% of patients, respectively. Among 220 patients with metastatic MTC, biochemical and objective responses were observed in 37.2 and 10.6% of the patients, respectively. Forty-six deaths were reported in 95 patients with advanced RR-DTC. In addition, 63 deaths were observed in 144 patients with metastatic MTC. Major side effects were reported in 124 patients treated with 90Y -based agent. In the patients treated with 177Lu-DOTA-TATE and 111In-Octreotide, mild and transient hematologic or renal complications were reported. Conclusion Findings of the study revealed that in the absence of the established treatment for the patients with RR-DTC and metastatic MTC, PRRT could be effective with few adverse events. Trial registration PROSPERO registration number: CRD42019125245.

Sporadic Medullary Thyroid Carcinoma: Towards a Precision Medicine

“…Furthermore, in a different cohort of 42 patients, almost 40% of them showed PD ( 198 ). Recently, a meta-analysis reviewed the efficacy of PRRT in patients with MTC, evaluating data from 220 patients ( 199 ). Unfortunately, the type of PRRT used was not described in 51 patients, most of the other patients were treated with 177Lu-based agent (n=157) and only a minority with 111In-based agent (n=12).…”

Molecular Imaging and Theragnostics of Thyroid Cancers

“…A total of 157 RAI-R DTC patients were treated with PPRT. Biochemical and objective responses (partial and complete) were observed in 25.3 and 10.5% of patients, respectively [ 81 ]. The main adverse events were nausea, asthenia, and transient hematologic toxicity.…”

“…Discontinuation of treatment due to toxicity is reported in only 1.3% of cases, hemotoxicity grade III–IV in 6.5% of cases, and nephrotoxicity grade III–IV in 0.8% [ 128 ]. Maghsoomi et al in a systematic review among 220 patients with metastatic MTC demonstrated biochemical and objective responses (partial and complete) in 37.2 and 10.6% of patients, respectively [ 81 ]. Satapathy et al showed that the disease control rate could be even higher (86%) if combining PRRT with a radiosensitizer, e.g., capecitabine [ 133 ].…”

Treatment of Neuroendocrine Neoplasms with Radiolabeled Peptides—Where Are We Now

“…Additional studies are warranted to assess effectiveness. A systematic review of 41 papers evaluating the use of PRRT in a subgroup of patients with SSTR positive radioiodine-refractory differentiated thyroid cancer and metastatic medullary thyroid cancer showed biochemical responses of 25.3-37.2% and objective response in 10.5-10.6%, with few adverse events identified [171]. It should be noted that individual study sizes were variable and the types of PRRT used, and patient populations were heterogenous, so the review concluded that multi-center randomized controlled trials are recommended to validate against other currently available treatments.…”