Somatostatin Receptor–Targeted Radiopeptide Therapy in Treatment-Refractory Meningioma: Individual Patient Data Meta-analysis

Abstract

Background: Somatostatin receptor (SSTR)-targeted peptide receptor radionuclide therapy (PRRT) represents a promising approach for treatment-refractory meningiomas. Methods: We performed an individual patient data (IPD) meta-analysis including all published meningioma patients treated with SSTR-targeted PRRT. Main outcomes were toxicity, response to treatment, progression-free survival (PFS), and overall survival (OS). We applied the Kaplan-Meier method to estimate survival probabilities and report incidence rates per 100 person-years. We applied Cox proportional hazards models to determine the effect of covariates. Results: We screened 537 papers, and identified six eligible cohort studies. We included a total of 111 patients with treatment-refractory meningioma who received SSTR-targeted PRRT. Disease control was achieved in 63% of patients. Six-month PFS was 94%, 48% and 0% for WHO (World Health Organization)-I,-II, &-III, respectively. The risk of disease progression decreased by 13% per 1000 MBq increase in the total applied activity. One-year OS was 88%, 71%, and 52% for WHO-I,-II &-III, respectively. The risk of death decreased by 17% per 1000-MBq increase of the total applied activity. Main side effects comprised transient hematotoxicities such as anemia in 22%, leukopenia in 13%, lymphocytopenia in 24%, and thrombocytopenia in 17% of patients. Conclusion: This IPD meta-analysis represents the most comprehensive analysis of benefits and adverse events of SSTR-targeted PRRT for treatment-refractory meningioma. The treatment was well tolerated, achieved disease control in most cases, and showed promising PFS and OS.

Bombesin Receptor Family Activation and CNS/Neural Tumors: Review of Evidence Supporting Possible Role for Novel Targeted Therapy

“…There are also numerous studies of PRRT with radiolabeled BnR analogues in patients with breast cancer (17,23,25,73,269), and other non-endocrine cancer cells (73), which show promise. Third, because of the success of tumor localization and PRRT-mediated cytotoxicity with radiolabeled somatostatin analogues in NETs, as well as limited studies showing promise with PRRT with radiolabeled somatostatin analogues in some patients with symptomatic/malignant CNS/neural tumors (meningiomas) (270)(271)(272)(273), malignant neuroblastomas (274,275), there is increased interest in applying nuclear medicine approaches to other CNS/ neural tumors (125,235,240,276,277).…”

Peptide Receptor Radionuclide Therapy and Primary Brain Tumors: An Overview

“…The expression of SSTR2 receptors may be delineated by positron emission tomography (PET) with radiolabeled somatostatin analogs [34]. Important results of PRRT with radiolabeled somatostatin analogs have been demonstrated [35,36], even in association with external beam radiotherapy [37].…”

“…Infusion of amino acids may be useful, reducing the renal uptake of radiopharmaceuticals [ 59 , 60 ]. Other side effects are represented by transient hematotoxicities such as anemia or leukopenia [ 35 ].…”

Two Birds with One Stone: Skull Base Meningioma and Jugulotympanic Paragangliomas with Somatostatin Receptor Positron Emission Tomography

“…Compared to MRI, SR-PET may add additional diagnostic information in patients with meningiomas, particularly in the differential diagnosis of newly diagnosed brain lesions suspicious for meningiomas, delineation of meningioma extent for resection or radiotherapy planning, and differentiation of tumor progression from a post-treatment change [2][3][4][5][6]. Furthermore, SR-PET may be useful to demonstrate the somatostatin receptors expression and to select progressive or treatment-refractory meningiomas which could benefit from peptide receptor radionuclide therapy (PRRT) which is usually a well-tolerated treatment in these patients achieving disease control in most cases [7]. Paragangliomas are neuroendocrine tumors arising from extra-adrenal chromaffine tissues and those located in head and neck region are usually characterized by increased expression of somatostatin receptors and, consequently, they are well-visualized by SR-PET which seems to be the best PET imaging modality for assessing this group of paragangliomas with excellent diagnostic performance [8][9][10].…”