Favourable outcomes of 177Lu-octreotate peptide receptor chemoradionuclide therapy in patients with FDG-avid neuroendocrine tumours

Abstract

PRCRT is an effective treatment in patients with FDG-avid NET, even in patients who have failed conventional therapies. Given apparently higher response rates than with alternative therapeutic options and low toxicity, further research is needed to establish whether PRCRT should be used as a first-line treatment modality in this patient population.

Reply: Modifying the Poor Prognosis Associated with 18F-FDG–Avid NET with Peptide Receptor Chemo-Radionuclide Therapy (PRCRT)

“…Finally, we agree with Hofman et al that, for metastatic NETs, therapeutic trials should now be conducted to define the best treatment course and confirm the highly interesting results reported in their study (5). In this setting, it would be intriguing to propose 18 F-FDG PET as an inclusion criterion, with the objective of including only patients with aggressive disease, assessed on the basis of 18 F-FDG avidity.…”

Pancreatic Neuroendocrine Tumor Control: Durable Objective Response to Combination ¹⁷⁷Lu-Octreotate-Capecitabine-Temozolomide Radiopeptide Chemotherapy

“…Favorable outcomes in relatively poor-prognosis 18 F-FDG PET-positive GEP-NET patients with advanced progressive 68 Ga-octreotate PET-avid disease have recently been achieved with a combination of 5-FU and 177 Lu-octreotate PRRT, with reported ORRs of CR in 2%, PR in 28%, SD in 68% and PD only in 2% of 58 patients and median PFS of 48 months [31]. A combination of radiosensitizing 5-FU chemotherapy with 177 Lu-octreotate PRRT gave rise to minimal self-limited toxicity [31], and our experience of substituting the oral prodrug capecitabine for intravenous 5-FU in conjunction with a standard course of 4 cycles of 7.9 GBq 177 Lu-octreotate in advanced GEP-NET patients showed only a modest increase in toxicity [32]. Even when temozolomide is added to the regimen, the hematological toxicity is modest and reversible in patients not heavily pretreated with prior chemotherapy or irradiation and a compromised marrow reserve [11,17].…”

Molecular imaging in the investigation of hypoglycaemic syndromes and their management

“…Ezzidin et al analysed 68 patients with Grade 1 or 2 progressive advanced pancreatic NETs treated with 177 Lu-DOTATATE resulting in PFS of 34 months, with reversible Grade 3 or more haematotoxicity in 5.9% and no significant nephrotoxicity (Ezziddin et al 2014). A series of 52 patients with metastatic FDG avid (predominantly Grade 2) GEP NET from our institution treated with 177 Lu-DOTATATE combined with radiosensitising 5-fluorouracil chemotherapy demonstrated PFS of 48 months with negligible Grade 3 or 4 toxicities (Kashyap et al 2015). Our practice has favoured treatment with PRRT for suitable patients given the markedly greater PFS compared to other available therapies and its minimal toxicity.…”