First demonstration of the effectiveness of peptide receptor radionuclide therapy (PRRT) with 111In-DTPA-octreotide in a giant PRL-secreting pituitary adenoma resistant to conventional treatment

Abstract

In prolactin-secreting giant adenomas, cabergoline treatment is the first line approach. Surgery and/or radiotherapy are indicated when the tumour is resistant to medical treatment and continues growing, causing visual field impairment. Data concerning other therapeutic approach are scanty. Although PRL-secreting tumours may express somatostatin receptors type 2, 3 and 5, somatostatin analogs treatment is generally ineffective and peptide receptor radionuclide therapy (PRRT) has never been reported. A 58 year-old woman complaining of severe neurological symptoms caused by a giant prolactinoma, relapsing after surgery and not-responding to dopamine-agonists and octreotide LAR treatment, underwent four cycles of PRRT with 111-Indium-DTPA-octreotide with remarkable tumour shrinkage and a significant improvement in clinical conditions. No side effects were reported. This is the first report on the effectiveness and safety of PRRT with radio-labelled somatostatin analogs in a patient with aggressive giant prolactinoma resistant to conventional treatment.

Peptide Receptor Radionuclide Therapy in Patients with Inoperable Meningiomas: Our Experience and Review of the Literature

“…49 It can be related to the high and homogeneous expression of somatostatin receptors in meningiomas that allows Auger and conversion electrons (characterized by extremely short penetration range and high linear energy transfer) to obtain cytotoxic effect. Moreover, the higher specific activity of 111 In-Pentetreotide than that reached by 90 Y-or 177 Lu-labeled DOTA-peptides and a lower injected mass of peptide 2,6,50,51 may be additional favorable features.…”

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

“…Patients received 2-4 cycles. Two patients demonstrated significant tumour shrinkage on treatment but one did not have a hormonal response (164,168). Three patients have been reported to have stable disease with follow-up of 1 year and 3.5 years in 2 of these patients (165,166,167).…”

“…Tumour uptake was assessed by octreoscan or 68Ga-DOTATATE PET/CT. Four patients were treated with 111Indium-DPTAoctreotide (164,165), 4 with 177Lutetium DOTATATE (25,166,167), 3 with 90Yttrium-DOTATOC (25,168,169) and 3 with 177Lutetium DOTATOC (11,25). Patients received 2-4 cycles.…”

Aggressive Pituitary Tumors

“…PRRT has been used with great success in neuroendocrine neoplasms, particularly gastroenteropancreatic [106]. Although experience with PRRT in pituitary tumors is limited, a significant tumor shrinkage and clinical improvement following administration of a course of 111 Indium-DTPA-octreotide in a patient with a recurrent giant prolactinoma resistant to conventional treatment have been described [107]. Symptomatic improvement and long-term control (8 years) were also reported in a patient with an atypical NFPA treated with 177 Lu-DOTATOC [108], whereas in a small case series of 3 patients treated with 177 Lu-DOTATATE, only 1 patient obtained a clinically useful response [109].…”