Sequelae and survivorship in patients treated with 131I-MIBG therapy

Abstract

Background:131I-meta-iodobenzylguanidine (131I-MIBG) has been in therapeutic use since 1980s. Newer treatment modalities are emerging for neuroendocrine tumours (NETs) and chromaffin cell tumours (CCTs), but many of these do not yet have adequate long-term follow-up to determine their longer term efficacy and sequelae.Methods:Fifty-eight patients with metastatic NETs and CCTs who had received 131I-MIBG therapy between 2000 and 2011 were analysed. Survival and any long-term haematological or renal sequelae were investigated.Results:In the NET group, the overall median survival and median survival following the diagnosis of metastatic disease was 124 months. The median survival following the commencement of 131I-MIBG was 66 months. For the CCT group, median survival had not been reached. The 5-year survival from diagnosis and following the diagnosis of metastatic disease was 67% and 67.5% for NETs and CCTs, respectively. The 5-year survival following the commencement of 131I-MIBG therapy was 68%. Thirty-two patients had long-term haematological sequelae: 5 of these 32 patients developed haematological malignancies. Two patients developed a mild deterioration in renal function.Conclusion:Long follow up of 131I-MIBG therapy reveals a noteable rate of bone marrow toxicities and malignancy and long term review of all patients receiving radionuclide therapies is recommended.

131I‐MIBG therapy for malignant paraganglioma and phaeochromocytoma: systematic review and meta‐analysis

“…Number of cycles received and cumulative dose were significantly higher in this subgroup compared with those who did not develop haematological malignancy in this cohort. Compared with our included studies, Sze et al . noted a substantial increase in the number of haematological events, including haematological malignancies.…”

“…Unfortunately, the timing at which these side effects were noted is missing in most cases. Sze et al . recently published a study about the incidence of persistent haematological and renal toxic effects after long‐term follow‐up of 131 I‐MIBG therapy in fourteen patients with PGL/PCC and 44 patients with NETs.…”

Local recurrence of pheochromocytoma in multiple endocrine neoplasia type 2A: a diagnostic and therapeutic challenge

“…Moreover, grades 3–4 renal and hematological toxicities of this treatment are estimated at <5% and 10%, respectively. However, long‐term follow‐up revealed leukemia in about 5% of patients . In our patient, MIBG therapy led to recurrence‐free follow‐up without short‐term or long‐term side effects.…”

Targeted Radionuclide Therapy

“…441 Some patients who received nonmyeloablative doses of 131 I have also had elevated thyroid-stimulating hormone levels at later times. 499,588 Leukemia risk for adults treated with 32 P for polycythemia appears dose related whereas leukemia has been noted after lower doses (0.6 mCi to 1.5 mCi) of intraarticular 32 P administration in children (FDA Medwatch). Parotiditis, which may result in xerostomia, has been more common with treatment of thyroid cancer than high dose radioconjugate therapy.…”