Radiolabeled Somatostatin Analog [¹⁷⁷Lu-DOTA⁰,Tyr³]Octreotate in Patients With Endocrine Gastroenteropancreatic Tumors

Abstract

Treatment with 177Lu-octreotate results in tumor remission in a high percentage of patients with GEP tumors. Serious side effects are rare. The median time to progression compares favorably with chemotherapy. Results are better in patients with a limited tumor load. Therefore, early treatment, even in patients who have no PD, may be better.

Peptide receptor radionuclide therapy for neuroendocrine tumours: standardized and randomized, or personalized?

“…In this large cohort of Romer et al, median survivals after 177 Lu and 90 Y-DOTA-TOC were 46 and 36 months, respectively. These results are consistent with those found in numerous other trials of PRRT [7][8][9][10][11][12][13][14][15]. In clinical practice, we frequently observe favourable responses with PRRT in patients with symptomatic, progressive disease resistant to all conventional therapy and often despite poor performance status.…”

“…A patient with high uptake on somatostatin receptor (SSTR) SPECT or PET imaging, without spatially discordant FDGavid poorly differentiated disease that cannot be targeted [18], is highly likely to have a favourable response to therapy. Moreover, the intensity of uptake on pretherapy imaging, being a surrogate for lesional dosimetry with therapy, also correlates with outcome [12]. Contrast this theranostic approach with conventional chemotherapy, whereby the likelihood of response is not individualized but estimated by the average response of a patient cohort defined by a prior RCT.…”

Peptide receptor radionuclide therapy with 177Lu-octreotate in patients with foregut carcinoid tumours of bronchial, gastric and thymic origin

“…Fifteen patients (94%) had grade 3 uptake on pretherapy SRS and one patient (6%) had grade 4 uptake. In the total group of GEP NETs, 3% had grade 2 uptake, 78% had grade 3 uptake and 19% had grade 4 uptake [14]. This difference was not statistically significant (Fisher's exact test, p>0.05).…”

“…Frequencies of several predictive factors for progressive disease as treatment outcome that were significant for the whole group of GEP NETs are presented in Table 2 for patients with foregut carcinoids and for patients from the total group of GEP NETs [14]. None of the differences was statistically significant (Fisher's exact test or Pearson χ 2 test).…”

“…This treatment results in tumour size reduction in 47% in patients from the total group of GEP NETs, including 19% minor response (MR, tumour size reduction ≥25%, <50%) [14]. Because of their different embryological origin, the present study was performed to evaluate whether foregut carcinoid tumours of bronchial, gastric and thymic origin respond differently to treatment with 177 Luoctreotate in comparison with the total group of GEP NETs.…”