Therapy-related myeloid neoplasm after peptide receptor radionuclide therapy (PRRT) in 1631 patients from our 20 years of experiences: prognostic parameters and overall survival

Chantadisai, Maythinee; Kulkarni, Harshad; Baüm, Richard

doi:10.1007/s00259-020-05127-9

Cited by 22 publications

(25 citation statements)

References 24 publications

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“…The most important long-term complications include myelodysplastic syndrome, acute myeloid leukemia, or bone marrow aplasia with the median latency period at diagnosis about 41 months ( 26 ). The prevalence of those severe, delayed adverse hematological events is estimated at 1.4%–4% ( 27 , 28 ). In case of PRRT radiopharmaceuticals labeled with 90Y, kidney-related toxicity should also be considered ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Value of Peptide Receptor Radionuclide Therapy as Neoadjuvant Treatment in the Management of Primary Inoperable Neuroendocrine Tumors

Opalińska¹,

Sowa‐Staszczak

Grochowska³

et al. 2021

Front. Oncol.

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IntroductionNeuroendocrine neoplasms including neuroendocrine tumors (NETs) are often diagnosed as primary disseminated or inoperable. In those cases, systemic extensive therapy is necessary, but radical treatment is unlikely. As described in the literature, in some selected cases, peptide receptor radionuclide therapy (PRRT) may be used as a first-line/neoadjuvant therapy that allows further successful surgery. Such treatment may enable a reduction of total tumor burden or allow a radical treatment which improves the final outcomes.AimThis study aims to assess whether neoadjuvant PRRT could be a treatment option for patients with initially unresectable NETs.MethodsAmong the group of 114 patients treated with PRRT between the years 2005 and 2020, in 32 cases, it was the first-line therapy, mainly due to massive disease burden at the time of diagnosis. Among them, nine patients received PRRT as the first-line treatment due to the primary inoperable tumors with the intention of preoperative reduction of the tumor size in order to allow for a surgical treatment.ResultsNeoadjuvant PRRT enabled surgery in four out of nine (45%) patients. Finally, in two out of four cases, the goal (radical surgery) has been achieved.ConclusionPRRT may be considered not only as a palliative but also as a neoadjuvant therapy in advanced, somatostatin-positive NETs that were initially inoperable.

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Section: Discussionmentioning

confidence: 99%

Value of Peptide Receptor Radionuclide Therapy as Neoadjuvant Treatment in the Management of Primary Inoperable Neuroendocrine Tumors

Opalińska¹,

Sowa‐Staszczak

Grochowska³

et al. 2021

Front. Oncol.

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“…Patients with bone metastases present a higher risk of myelotoxicity [156]. Finally, acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) are severe long-term complications related to PRRT and were reported to occur in approximately 0.5 and 1.5% of patients, respectively, after a median of 55 and 28 months following PRRT [11,136,157]. Patients that have received prior alkylating chemotherapy are at greater risk of developing MDS/acute leukemia following PRRT [158,159] Radiolabeled SSTR2 antagonists, such as 177Lu-satoreotide tetraxetan, have shown higher tumor uptake, independent of SSTR activation, and greater tumor-to-organ ratios than agonists in preclinical models [160].…”

Section: Somatostatin Receptors and Other Unique Targets In Nets 41 Rationale For Targeting Sstmentioning

confidence: 99%

Targeted Cancer Therapy: What’s New in the Field of Neuroendocrine Neoplasms?

Salvia

Espinosa-Olarte

Riesco-Martinez

et al. 2021

Cancers

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Neuroendocrine tumors (NETs) are a heterogeneous family of neoplasms of increasing incidence and high prevalence due to their relatively indolent nature. Their wide anatomic distribution and their characteristic ability to secrete hormonally active substances pose unique challenges for clinical management. They are also characterized by the common expression of somatostatin receptors, a target that has been extremely useful for diagnosis and treatment (i.e., somatostatin analogues (SSAs) and peptide-receptor radionuclide therapy (PRRT)). Chemotherapy is of limited use for NETs of non-pancreatic origin, and the only approved targeted agents for advanced progressive NETs are sunitinib for those of pancreatic origin, and everolimus for lung, gastrointestinal and pancreatic primaries. Despite recent therapeutic achievements, thus, systemic treatment options remain limited. In this review we will discuss the state-of-the-art targeted therapies in the field of NETs, and also future perspectives of novel therapeutic drugs or strategies in clinical development, including recently presented results from randomized trials of yet unapproved antiangiogenic agents (i.e., pazopanib, surufatinib and axitinib), PRRT including both approved radiopharmaceuticals (177Lu-Oxodotreotide) and others in development (177Lu-Edotreotide, 177Lu-Satoreotide Tetraxetan), immunotherapy and other innovative targeted strategies (antibody-drug conjugates, bites,…) that shall soon improve the landscape of personalized treatment options in NET patients.

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“…The origin of radiation-induced t-MN is very intricate and includes the formation of single or double strand breaks in the DNA, which can eventually lead to genetic mutations, including loss of function or oncogene activation [ 89 ]. Studies including large datasets, report an incidence of PHD after PRRT between 1.8 and 4.8%, with a median latency of 41 months [ 89 , 97 , 98 , 99 ]. Brieau et al reported an incidence of t-MN of 20% after PRRT, in a limited subgroup of 20 patients heavily pretreated with alkylating chemotherapy [ 100 ].…”

Section: Toxicitymentioning

confidence: 99%

Peptide Receptor Radionuclide Therapy Targeting the Somatostatin Receptor: Basic Principles, Clinical Applications and Optimization Strategies

Bidakhvidi

Goffin

Dekervel

et al. 2021

Cancers

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Peptide receptor radionuclide therapy (PRRT) consists of the administration of a tumor-targeting radiopharmaceutical into the circulation of a patient. The radiopharmaceutical will bind to a specific peptide receptor leading to tumor-specific binding and retention. The only target that is currently used in clinical practice is the somatostatin receptor (SSTR), which is overexpressed on a range of tumor cells, including neuroendocrine tumors and neural-crest derived tumors. Academia played an important role in the development of PRRT, which has led to heterogeneous literature over the last two decades, as no standard radiopharmaceutical or regimen has been available for a long time. This review provides a summary of the treatment efficacy (e.g., response rates and symptom-relief), impact on patient outcome and toxicity profile of PRRT performed with different generations of SSTR-targeting radiopharmaceuticals, including the landmark randomized-controlled trial NETTER-1. In addition, multiple optimization strategies for PRRT are discussed, i.e., the dose–effect concept, dosimetry, combination therapies (i.e., tandem/duo PRRT, chemoPRRT, targeted molecular therapy, somatostatin analogues and radiosensitizers), new radiopharmaceuticals (i.e., SSTR-antagonists, Evans-blue containing vector molecules and alpha-emitters), administration route (intra-arterial versus intravenous) and response prediction via molecular testing or imaging. The evolution and continuous refinement of PRRT resulted in many lessons for the future development of radionuclide therapy aimed at other targets and tumor types.

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Therapy-related myeloid neoplasm after peptide receptor radionuclide therapy (PRRT) in 1631 patients from our 20 years of experiences: prognostic parameters and overall survival

Cited by 22 publications

References 24 publications

Value of Peptide Receptor Radionuclide Therapy as Neoadjuvant Treatment in the Management of Primary Inoperable Neuroendocrine Tumors

Value of Peptide Receptor Radionuclide Therapy as Neoadjuvant Treatment in the Management of Primary Inoperable Neuroendocrine Tumors

Targeted Cancer Therapy: What’s New in the Field of Neuroendocrine Neoplasms?

Peptide Receptor Radionuclide Therapy Targeting the Somatostatin Receptor: Basic Principles, Clinical Applications and Optimization Strategies

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