Resistant functioning and/or progressive symptomatic metastatic gastroenteropancreatic neuroendocrine tumors

Kalshetty, Ashwini; Ramaswamy, Anant; Ostwal, Vikas; Basu, Sandip

doi:10.1097/mnm.0000000000000926

Cited by 13 publications

(6 citation statements)

References 15 publications

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“…In cases of locally advanced inoperable PNET or disseminated disease, systemic treatment is often initiated. During recent years, PRRT with 177 Lu-DOTATATE is increasingly used when other regimens, such as chemotherapies or targeted molecular agents, have failed (15)(16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

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Tumor Contrast-Enhancement for Monitoring of PRRT 177Lu-DOTATATE in Pancreatic Neuroendocrine Tumor Patients

et al. 2020

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Section: Discussionmentioning

confidence: 99%

“…During recent years, PRRT with 177 Lu-DOTATATE is increasingly used when other therapies have failed. Treatment may be repeated after a few years in case of disease progression, so called "salvage therapy" administering a reduced number of cycles (15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Tumor Contrast-Enhancement for Monitoring of PRRT 177Lu-DOTATATE in Pancreatic Neuroendocrine Tumor Patients

et al. 2020

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“…While the CLARINET and PROMID trials confirmed the role of lanreotide and octreotide LAR in NENs with MIB indices <10%, there is a significant heterogeneity in terms of the appropriate treatment for patients with MIB index >10%. Peptide radionuclide receptor therapy with 177 Lu-DOTATATE PRRT is, now, an established option for midgut NENs who have progressed on SSA [6, 7]. Capecitabine-temozolomide (CAPTEM) and capecitabine are chemotherapeutic agents that are also acceptable options post-progression, with randomized evidence to suggest potential superiority of CAPTEM over capecitabine alone [8].…”

Section: Introductionmentioning

confidence: 99%

Capecitabine-Temozolomide in Advanced Grade 2 and Grade 3 Neuroendocrine Neoplasms: Benefits of Chemotherapy in Neuroendocrine Neoplasms with Significant 18FDG Uptake

et al. 2020

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Introduction: Capecitabine-temozolomide (CAPTEM) chemotherapy, alone or with concurrent peptide receptor radionuclide therapy (PRRT), has activity in advanced WHO grade 2 and grade 3 neuroendocrine neoplasms (NENs). The objective of this study was to evaluate the activity of the CAPTEM in patients with grade 2 and grade 3 NENs and identify prognostic factors. Materials and Methods: A retrospective analysis of patients with metastatic grade 2 and grade 3 NENs, who were having baseline significant dual uptake on 68Ga-DOTATATE/18F-fluorodeoxyglucose (FDG)-PET-CT scan and treated with CAPTEM chemotherapy between January 2014 and December 2019 at Tata Memorial Hospital, was conducted. The clinical variables and survival data were collected. Progression-free survival (PFS) was estimated using the Kaplan-Meier method. Results: A total of 68 patients received the CAPTEM regimen, of whom 29 patients (43%) received CAPTEM alone and 39 patients (57%) received concurrent PRRT. The primary sites were pancreas in 32 (47%) and small intestine in 12 (18%) patients. Mean Ki-67 index was 12.6% (range: 3–50). Forty-five patients (65%) were treatment naïve. There were no significant differences in baseline clinical variables between patients treated with CAPTEM alone or with CAPTEM-PRRT. Both regimens were well tolerated. With a median follow-up of 22.1 months, the median PFS for the entire cohort was 27.5 months. There was no statistical difference in the median PFS between patients receiving CAPTEM alone or CAPTEM-PRRT (33.7 vs. 22 months; p = 0.199). A Ki-67 index of >5% predicted for inferior PFS on multivariate analysis (24 versus 73.8 months; p = 0.04; hazard ratio −3.77; 95% confidence interval: 1.07–13.26). Conclusion: CAPTEM, alone or concurrent with PRRT, has a significant activity in grade 2 and grade 3 NENs with dual SSTR and 18FDG expression. A Ki-67 index >5% predicts strongly for inferior outcomes and should be further explored as a prognostic cutoff in grade 2 NENs. Early initiation of CAPTEM should be considered in this group of tumors with significant baseline 18FDG expression.

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“…files 1–3; for all online suppl. material, see www.karger.com/doi/10.1159/000516015) [65]. One such postulated role is for PRRT to serve as neoadjuvant therapy in patients with inoperable GEP-NETs.…”

Section: Emerging Research On the Utility Of Prrtmentioning

confidence: 99%

The State of Peptide Receptor Radionuclide Therapy and Its Sequencing among Current Therapeutic Options for Gastroenteropancreatic Neuroendocrine Tumors

et al. 2021

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Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are the most common form of neuroendocrine neoplasia, but there is no current consensus for the sequencing of approved therapies, particularly with respect to peptide receptor radionuclide therapy (PRRT). This comprehensive review evaluates the data supporting approved therapies for GEP-NETs and recommendations for therapeutic sequencing with a focus on how PRRT currently fits within sequencing algorithms. The current recommendations for PRRT sequencing restrict its use to metastatic, inoperable, progressive midgut NETs, however, this may change with emerging data to suggest PRRT might be beneficial as neoadjuvant therapy for inoperable tumors, is more tolerable than other treatment modalities following first-line standard dose somatostatin analogues, and can be used as salvage therapy after disease relapse following prior successful cycles of PRRT. PRRT has also been shown to reduce tumor burden, improve quality of life, and prolong the time to disease progression in a broad spectrum of patients with GEP-NETs. As the various potential benefits of PRRT in GEP-NET therapy continues to expand, it is necessary to review and critically evaluate our treatment algorithms for GEP-NETs.

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Resistant functioning and/or progressive symptomatic metastatic gastroenteropancreatic neuroendocrine tumors

Cited by 13 publications

References 15 publications

Tumor Contrast-Enhancement for Monitoring of PRRT 177Lu-DOTATATE in Pancreatic Neuroendocrine Tumor Patients

Tumor Contrast-Enhancement for Monitoring of PRRT 177Lu-DOTATATE in Pancreatic Neuroendocrine Tumor Patients

Capecitabine-Temozolomide in Advanced Grade 2 and Grade 3 Neuroendocrine Neoplasms: Benefits of Chemotherapy in Neuroendocrine Neoplasms with Significant <sup>18</sup>FDG Uptake

The State of Peptide Receptor Radionuclide Therapy and Its Sequencing among Current Therapeutic Options for Gastroenteropancreatic Neuroendocrine Tumors

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