ABSTRACT
BACKGROUND: Peptide receptor radionuclide therapy (PRRT) is one of the most promising therapeutic strategies in neuroendocrine neoplasms (NENs). Nevertheless, its role in certain tumor sites remains unclear. This study sought to elucidate the efficacy and safety of [177Lu]Lu-DOTATATE in NENs with different locations and evaluate the effect of the tumor origin, bearing in mind other prognostic variables. Advanced NENs overexpressing somatostatin receptors (SSTRs) on functional imaging, of any grade or location, treated at 24 centers were enrolled. The protocol consisted of four cycles of 177Lu-DOTATATE 7.4 GBq iv every 8 weeks (NCT04949282). RESULTS: The sample comprised 522 subjects with pancreatic (35%), midgut (28%), bronchopulmonary (11%), pheochromocytoma/ paraganglioma (PPGL) (6%), other gastroenteropancreatic (GEP) (11%), and other non-gastroenteropancreatic (NGEP) (9%) NENs. The best RECIST 1.1 responses were complete response, 0.7%; partial response, 33.2%; stable disease, 52.1%; and tumor progression, 14%, with activity conditioned by the tumor subtype, but with benefit in all strata. Median progression-free survival (PFS) was 31.3 months (95% CI, 25.7-not reached [NR]) in midgut, 30.6 months (14.4-NR) in PPGL, 24.3 months (18.0-NR) in other GEP, 20.5 months (11.8-NR) in other NGEP, 19.8 months (16.8-28.1) in pancreatic, and 17.6 months (14.4-33.1) in bronchopulmonary NENs. [177Lu]Lu-DOTATATE exhibited scant severe toxicity. CONCLUSION: This study confirms the efficacy and safety of [177Lu]Lu-DOTATATE in a wide range of SSTR-expressing NENs, regardless of location, with clinical benefit and superimposable survival outcomes between pNENs and other GEP and NGEP tumor subtypes different from midgut NENs.
Subject(s)
Adrenal Gland Neoplasms , Neuroendocrine Tumors , Organometallic Compounds , Paraganglioma , Pheochromocytoma , Humans , Octreotide/adverse effects , Neuroendocrine Tumors/pathology , Prognosis , Receptors, Somatostatin , Organometallic Compounds/adverse effectsABSTRACT
Neuroendocrine tumors (NET) are a heterogeneous group of neoplasms that originate in tissues derived from the neural crest, whose characteristic feature is the expression of neuroendocrine markers and somatostatin receptors. Here, we present the case of a patient with a surgically intervened small bowel NET. Focal uptake was identified in the unresected mesentery in the scintigraphy of somatostatin receptors (99mTc-Tektrotyd). A second intervention was performed with intraoperative radio-guided detection with a gamma probe and a handheld SPECT. An intraoperative radioguided technique allowed the detection of a lesion that was confirmed by histology to be a lymph node metastasis of the NET and a nodule of NET in the anastomosis of the first surgical intervention.
Subject(s)
Breast Neoplasms , Neuroendocrine Tumors , Pancreatic Neoplasms , Female , Humans , Lymphatic Metastasis , Neuroendocrine Tumors/diagnostic imaging , Neuroendocrine Tumors/surgery , Pancreatic Neoplasms/diagnostic imaging , Radionuclide Imaging , RadiopharmaceuticalsABSTRACT
Los tumores neuroendocrinos (TNE) son un grupo heterogéneo de neoplasias que tienen origen en tejidos derivados de la cresta neural, que expresan marcadores neuroendocrinos y receptores de somatostatina. Presentamos el caso de una paciente con un TNE de intestino delgado previamente intervenido. En la gammagrafía de receptores de somatostatina (GRS/99mTc-Tektrotyd) se identificó un foco en mesenterio no resecado. Se realizó una segunda intervención con detección radioguiada con sonda gamma y con SPECT-portátil. Permitió detectar una lesión que se confirmó por histología como metástasis ganglionar de TNE y un nódulo de TNE en la anastomosis de la primera intervención quirúrgica
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