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Symptomatic and Radiological Response to 177Lu-DOTATATE for the Treatment of Functioning Pancreatic Neuroendocrine Tumors

Zandee, W. T., Brabander, T., Blažević, A., Kam, B. L. R., Teunissen, J. J. M., Feelders, R. A., Hofland, J. & de Herder, W. W., 1-Apr-2019, In : Journal of Clinical Endocrinology and Metabolism. 104, 4, p. 1336-1344 9 p.

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DOI

  • Wouter T Zandee
  • Tessa Brabander
  • Anela Blažević
  • Boen L R Kam
  • Jaap J M Teunissen
  • Richard A Feelders
  • Johannes Hofland
  • Wouter W de Herder

PURPOSE: Peptide receptor radionuclide therapy (PRRT) with the radiolabeled somatostatin analogue [Lutetium-177-DOTA0-Tyr3]octreotate (177Lu-DOTATATE) is widely applied for inoperable metastatic small intestinal and nonfunctioning pancreatic neuroendocrine tumors (pNETs). The aim of this study is to describe the safety and efficacy of the treatment of functioning pNETs.

METHODS: Patients were treated with up to four cycles of 177Lu-DOTATATE with an intended dose of 7.4 Gbq per cycle. Radiological (Response Evaluation Criteria in Solid Tumors 1.1), symptomatic, and biochemical response were analyzed retrospectively for all patients with a functioning pNET (insulinoma, gastrinoma, VIPoma, and glucagonoma) treated with 177Lu-DOTATATE. Quality of life (QOL) was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core Module questionnaire.

RESULTS: Thirty-four patients with a metastatic functioning pNET (European Neuroendocrine Tumor Society grade 1 or 2) were included: 14 insulinomas, 5 VIPomas, 7 gastrinomas, and 8 glucagonomas. Subacute hematological toxicity, grade 3 or 4 occurred in 4 patients (12%) and a hormonal crisis in 3 patients (9%). PRRT resulted in partial or complete response in 59% of patients and the disease control rate was 78% in patients with baseline progression. 71% of patients with uncontrolled symptoms had a reduction of symptoms and a more than 80% decrease of circulating hormone levels was measured during follow-up. After PRRT, median progression-free survival was 18.1 months (interquartile range: 3.3 to 35.7) with a concurrent increase in QOL.

CONCLUSION: Treatment with 177Lu-DOTATATE is a safe and effective therapy resulting in radiological, symptomatic and biochemical response in a high percentage of patients with metastatic functioning pNETs. Hormonal crises occur relatively frequent and preventive therapy should be considered before and/or during PRRT.

Original languageEnglish
Pages (from-to)1336-1344
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number4
Publication statusPublished - 1-Apr-2019
Externally publishedYes

    Keywords

  • Adult, Aged, Coordination Complexes/administration & dosage, Female, Gastrins/blood, Glucagon/blood, Humans, Insulin/blood, Lutetium/administration & dosage, Male, Middle Aged, Neuroendocrine Tumors/blood, Octreotide/administration & dosage, Pancreas/metabolism, Pancreatic Neoplasms/blood, Quality of Life, Radiation Dosage, Radioisotopes/administration & dosage, Response Evaluation Criteria in Solid Tumors, Retrospective Studies, Vasoactive Intestinal Peptide/blood

ID: 125082711