Real‐world efficacy of lutetium peptide receptor radionuclide therapy in patients with neuroendocrine tumours

Abstract

Lutetium peptide receptor radio nuclide therapy (Lu-PRRT) is an effective treatment for progressive, metastatic, somatostatin-receptor-positive, well-differentiated neuroendocrine tumours (WD-NETs). Here, we report a single centre experience of real-world efficacy, long-term side effects, and challenges of this treatment. This was a retrospective analysis. All patients linked with our centre who had Lu-PRRT were included. Clinicopathological data were analysed using descriptive statistics, Kaplan-Meier, and Cox regression. A total of 45 patients had Lu-PRRT, of those 30 (67%) were males, and 13 (29%) were more than 65 years old. The primary site was small intestine in 30 (67%) patients, pancreas in seven (16%) patients, and lung in three (7%) patients. The tumor was grade 1 in 15 (35%) patients, grade 2 in 22 (48%) patients, and grade 3 in six (13%) patients. A total of 41 (91%) patients had liver metastasis, and 20 (44%) patients had carcinoid syndrome. Lu-PRRT was the secondline therapy in all patients. Krenning's score was 4 in 36 (80%) patients and 3 in nine (20%) patients. The median waiting time to start Lu-PRRT therapy was 87 days. The median follow-up was 41 months. A total of 23 (51%) patients had a partial response, 18 (40%) patients had stable disease, and four (9%) patients had progression. None of the patients had a complete response. The median progression-free survival (PFS) was 38 months (95% CI: 25.8-50.1). The median overall survival (OS) was not reached. Nine patients died during follow-up (death from any cause). Prior treatment with targeted therapies or high dose somatostatin analogues were negative predictors of Lu-PRRT outcome (p-values of < .001 and < .045, respectively). There were two serious haematological toxicities, one patient developed acute myeloid leukaemia (AML), and the other developed chronic myeloid leukaemia (CML).Lu-PRRT is an effective second-line treatment for metastatic WD-NETs. The effect of targeted therapies on Lu-PRRT outcome was significant and needs to be clarified in further studies.

The risk and prognostic factors for G1 pancreatic neuroendocrine tumors: A retrospective analysis of the SEER database

“…Chemotherapy options include temozolomide with or without capecitabine ( 23 ), but for pNETs, especially with distant metastases, the efficacy is not as good as targeted therapy. Peptide receptor radionuclide therapy (PRRT) is recommended when the disease progresses after targeted therapy or chemotherapy or when there is no significant improvement in clinical symptoms ( 31 , 36 – 38 ). 177 Lu-PRRT can achieve long-term survival in patients with locally advanced or oligometastatic pNETs ( 39 , 40 ).…”

Application Prospect of Radionuclide Tracer Technology in Clinical Imaging Therapy and Drug Development

“…To produce new radionuclides, it is necessary to establish a medium-energy (about 100MeV) and high-throughput proton accelerator [17]. The future of radionuclide tracing technology lies in personalized medicine, that is, the attending doctor selects the appropriate radionuclide and carrier according to each patient's condition [18]. The use of ionizing radiation from radionuclides to kill tumor cells is one of the most promising treatments for cancer, both now and for the foreseeable future.…”