The Challenges of Treating Paraganglioma Patients with 177Lu-DOTATATE PRRT: Catecholamine Crises, Tumor Lysis Syndrome and the Need for Modification of Treatment Protocols

Makis, William; McCann, Karey; McEwan, Alexander

doi:10.1007/s13139-015-0332-6

Cited by 29 publications

(21 citation statements)

References 34 publications

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“…In this case, the patient was pretreated with glucocorticoids which may induce catecholamine crisis, as recently described in the literature [ 40 ]. Other centers have reported, 24 h following 177-LUDOTATE infusion, severe tumoral lysis syndrome which led to severe hypertension, shortness of breath, tachycardia, hyperkalemia, hyperphosphatemia and hypocalcemia with necessary admission to ICU [ 22 ]. Other patients developed severe hypotension or severe tachycardia during treatment infusion [ 16 , 17 , 21 , 22 , 25 , 26 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…Frequently, patients during treatment with 177 LU-DOTA-TATE are pretreated with glucocorticoids infusion; however, this pre-treatment is concerning as catecholamine crisis induced by exogenous glucocorticoids has been described recently. Thus, pre-treatment with glucocorticoids should be avoided [ 16 , 17 , 22 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, there are several protocols of how to perform radioisotope infusion, and it seems that 177-LUDOTA-TATE infusion should be administered over 2 h at least and preferably over 4 h and not in 15–30 min as described in the literature. During infusion the patient should be monitored closely and intensive care support should be available if needed [ 22 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is therefore a clinical spectrum, but currently no accepted classification system for this hormonal crisis. In order to control this, general measures and specific treatments can be applied ( Table 4 ) [ 17 , 22 , 43 , 44 , 45 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tumoral lysis after treatment produces a deposit of uric acid and calcium phosphate crystals in the renal tubules with consequent deterioration of kidney function. It is an uncommon complication, but it is important to keep it in mind due to its appearance 2–4 days after treatment [ 22 , 52 ]. Treatment prevention is essential, with adequate hydration and analysis that includes electrolytes, uric acid and kidney function.…”

Section: Discussionmentioning

confidence: 99%

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Prevention and Management of Hormonal Crisis during Theragnosis with LU-DOTA-TATE in Neuroendocrine Tumors. A Systematic Review and Approach Proposal

García

Muros

López-de-la-Torre

et al. 2020

JCM

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Neuroendocrine tumors (NETs) frequently overexpress somatostatin receptors (SSTR) on their cell surface. The first-line pharmacological treatment for inoperable metastatic functioning well-differentiated NETs are somatostatin analogs. On second line, Lu-DOTA-TATE (177Lu-DOTA0 Tyr 3 octreotate) has shown stabilization of the disease and an increase in progression free survival, as well as effectiveness in controlling symptoms and increasing quality of life. The management of functional NETs before and during LU-DOTA-TATE treatment is specially challenging, as several complications such as severe carcinoid and catecholamine crisis have been described. The aim of this review is to establish practical guidance for the management and prevention of the most common hormonal crises during radionuclide treatment with Lu-DOTA-TATE: carcinoid syndrome (CS) and catecholamine hypersecretion, as well as to provide a brief commentary on other infrequent metabolic complications. To establish a practical approach, a systematic review was performed. This systematic review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and conducted using MEDLINE (accessed from PubMed), Google Scholar and ClinicalTrials.gov. Literature searches found 449 citations, and finally nine were considered for this systematic review.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Prevention and Management of Hormonal Crisis during Theragnosis with LU-DOTA-TATE in Neuroendocrine Tumors. A Systematic Review and Approach Proposal

García

Muros

López-de-la-Torre

et al. 2020

JCM

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Radiolabeled Somatostatin Analogues in the Treatment of Non-GEP-NET Tumors

Versari¹,

Filice²,

Casali³

et al. 2018

Clinical Applications of Nuclear Medicine Targeted Therapy

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PRRT: identikit of the perfect patient

Albertelli

Dotto

Dato

et al. 2020

Rev Endocr Metab Disord

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Peptide receptor radionuclide therapy (PRRT) has been strengthened since the publication of NETTER-1. Nevertheless, the correct positioning in the therapeutic algorithm is debated, and no optimal sequence has yet been standardized. Possible criteria to predict the response to PRRT in neuroendocrine tumors (NET) have been proposed. The aim of this review is to define the perfect identity of the eligible patient who can mostly benefit from this therapy. Possible predictive criteria which have been analysed were: primary tumor site, grading, tumor burden, FDG PET and 68Ga-PET uptake. Primary tumor site and 68Ga-PET uptake do not play a pivotal role in predicting the response, while tumor burden, FDG PET uptake and grading seem to represent predictive/prognostic factors for response to PRRT. The heterogeneity in trial designs, patient populations, type of radionuclides, previous therapies and measurement of outcomes, inevitably limits the strength of our conclusions, therefore care must be taken in applying these results to clinical practice. In conclusion, the perfect patient, selected by 68Ga-PET uptake, will likely have a relatively limited liver tumor burden, a ki67 index <20% and will respond to PRRT irrespective to primary tumor. Nevertheless, we have mostly prognostic than predictive factors to predict the efficacy of PRRT in individual patients, while a promising tool could be the NETest. However, to date, the identikit of the perfect patient for PRRT is a puzzle without some pieces and still we cannot disregard a multidisciplinary discussion of the individual case to select the patients who will mostly benefit from PRRT.

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The Challenges of Treating Paraganglioma Patients with 177Lu-DOTATATE PRRT: Catecholamine Crises, Tumor Lysis Syndrome and the Need for Modification of Treatment Protocols

Cited by 29 publications

References 34 publications

Prevention and Management of Hormonal Crisis during Theragnosis with LU-DOTA-TATE in Neuroendocrine Tumors. A Systematic Review and Approach Proposal

Prevention and Management of Hormonal Crisis during Theragnosis with LU-DOTA-TATE in Neuroendocrine Tumors. A Systematic Review and Approach Proposal

Radiolabeled Somatostatin Analogues in the Treatment of Non-GEP-NET Tumors

PRRT: identikit of the perfect patient

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