Peptide receptor radionuclide therapy with 177Lu-DOTA-TATE as a promising treatment of malignant insulinoma: a series of case reports and literature review

Magalhães, Diogo; Sampaio, Inês Lucena; Ferreira, Gonçalo Cordeiro; Bogalho, Paula; Martins-Branco, Diogo; Santos, Rui; Duarte, Hugo

doi:10.1007/s40618-018-0911-3

Cited by 28 publications

(20 citation statements)

References 35 publications

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“…Our data support previous results from the few retrospective studies with small series of patients including insulin secreting metastatic NETs, confirming the role of PRRT in relieving hypoglycaemic symptoms (6,7,15,16,17,18).…”

Section: Discussionsupporting

confidence: 90%

“…Curative surgery is rarely applicable due to the widespread metastases of the tumor, but debulking surgery can result in a symptomatic improvement and can improve the efficacy of systemic or locoregional therapies. Peptide Receptor Radionuclide Therapy (PRRT) is an effective treatment option for hormonal syndrome relief and reduction or stabilization of tumor burden in NETs in general; however, the experience in malignant insulinoma, even if promising, is very limited (5,6,7).…”

Section: Introductionmentioning

confidence: 99%

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Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Veltroni

Cosaro

Spada

et al. 2020

European Journal of Endocrinology

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Introduction Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma. Materials and methods Multicenter retrospective study on 31 patients (male: 61.3%) diagnosed between 1988 and 2017. Results The mean age at diagnosis was 48 years. The mean NET diameter was 41 ± 31 mm, and 70.8% of NETs were G2. Metastases were widespread in 38.7%, hepatic in 41.9% and only lymph nodal in 19.4%. In 16.1% of the cases, the hypoglycaemic syndrome occurred after 46 ± 35 months from the diagnosis of originally non-functioning NET, whereas in 83.9% of the cases it led to the diagnosis of NET, of which 42.3% with a mean diagnostic delay of 32.7 ± 39.8 months. Surgical treatment was performed in 67.7% of the cases. The 5-year survival rate was 62%. Overall survival was significantly higher in patients with Ki-67 ≤10% (P = 0.03), insulin level <60 µU/mL (P = 0.015) and in patients who underwent surgery (P = 0.006). Peptide Receptor Radionuclide Therapy (PRRT) was performed in 45.1%, with syndrome control in 93% of patients. Conclusions Our study includes the largest series of patients with malignant insulinoma reported to date. The hypoglycaemic syndrome may occur after years in initially non-functioning NETs or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 ≤10% are prognostic factors associated with better survival. PPRT proved to be effective in the control of hypoglycaemia in majority of cases.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Veltroni

Cosaro

Spada

et al. 2020

European Journal of Endocrinology

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“…In addition, the median OS was reported to be 45 months in the patients that were considered as responders. In terms of malignant insulinomas, there is a limited amount of data by means of case reports or series that indicate a positive result of PRRT in stabilization of disease as well as hypoglycemia ( 130 , 131 ). Another recently published retrospective study, which had 34 functional pNET patients with metastasis and persistent hormonal symptoms included in it, reported that most patients (71%) showed a significant improvement in terms of the functional syndrome and 80% of them showed a decrease in the circulating levels of related hormones.…”

Section: Sstr-targeted Therapy In Pnetmentioning

confidence: 99%

Role of Somatostatin Receptor in Pancreatic Neuroendocrine Tumor Development, Diagnosis, and Therapy

Zeng

Wang

et al. 2021

Front. Endocrinol.

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Pancreatic neuroendocrine tumors (pNETs) are rare and part of the diverse family of neuroendocrine neoplasms (NENs). Somatostatin receptors (SSTRs), which are widely expressed in NENs, are G-protein coupled receptors that can be activated by somatostatins or its synthetic analogs. Therefore, SSTRs have been widely researched as a diagnostic marker and therapeutic target in pNETs. A large number of studies have demonstrated the clinical significance of SSTRs in pNETs. In this review, relevant literature has been appraised to summarize the most recent empirical evidence addressing the clinical significance of SSTRs in pNETs. Overall, these studies have shown that SSTRs have great value in the diagnosis, treatment, and prognostic prediction of pNETs; however, further research is still necessary.

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“…For malignant insulinomas, there is limited data in the form of case reports/series suggesting a benefit of PRRT in both stabilizing disease and hypoglycemia. 75,76 A recent retrospective study of 34 patients with metastatic functional pNETs and refractory hormonal symptoms found that the majority (71%) had a significant improvement in the functional syndrome and 80% had a reduction in the corresponding circulating hormone levels. After PRRT, the median PFS was 18.1 months and was associated with a concurrent increase in quality of life (QoL).…”

Section: Functional Pannetsmentioning

confidence: 99%

<p>Peptide Receptor Radionuclide Therapy for the Treatment of Pancreatic Neuroendocrine Tumors: Recent Insights</p>

Starr¹,

Sonbol

Hobday

et al. 2020

OTT

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Peptide receptor radionuclide therapy (PRRT) is a paradigm shifting approach to the treatment of neuroendocrine tumors. Although there are no prospective randomized trials directly studying PRRT in pancreatic neuroendocrine tumors (panNETs), there are data to suggest benefit in this patient population. Collectively, the data, consisting of two prospective and six retrospective studies, show a median PFS ranging from 20 to 39 months and a median OS ranging from 37 to 79 months. There are ongoing (and upcoming) prospective, randomized trials of PRRT in panNETs, which will provide further evidence to support this approach.

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Peptide receptor radionuclide therapy with 177Lu-DOTA-TATE as a promising treatment of malignant insulinoma: a series of case reports and literature review

Abstract: After the start of Lu-DOTA-TATE all patients achieved hypoglycaemia symptomatic control and had evident improvement of their quality of life. Three patients showed imagiological improvement suggesting reduced tumour load.

Cited by 28 publications

References 35 publications

Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Role of Somatostatin Receptor in Pancreatic Neuroendocrine Tumor Development, Diagnosis, and Therapy

<p>Peptide Receptor Radionuclide Therapy for the Treatment of Pancreatic Neuroendocrine Tumors: Recent Insights</p>

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