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European Journal of Nuclear Medicine and Molecular Imaging

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03-05-2022 | Carcinoid Tumor | Original Article

In patients with well-differentiated neuroendocrine tumours, there is no apparent benefit of somatostatin analogues after disease control by peptide receptor radionuclide therapy

Authors: Aleksandra Syguła, Aleksandra Ledwon, Kornelia Hasse-Lazar, Beata Jurecka-Lubieniecka, Barbara Michalik, Ewa Paliczka-Cieślik, Marcin Zeman, Ewa Chmielik, Joanna Sczasny, Barbara Jarzab, Daria Handkiewicz-Junak

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2022

Abstract

Purpose

Peptide receptor radionuclide therapy (PRRT) and somatostatin analogues (SSAs) are commonly combined as primary treatment for neuroendocrine neoplasms (NEN), and SSAs given as maintenance. We sought to evaluate whether sequential therapy with PRRT followed by SSAs has progression or survival benefits in patients with NEN after disease control by PRRT.

Methods

This prospective, randomised, single-centre study had as principal eligibility criteria: unresectable, locally advanced, or metastatic, histologically confirmed well-differentiated NEN; no symptoms/biochemical diagnosis of carcinoid syndrome; no SSAs or ≤ 3 months of SSAs before PRRT; and stable disease or partial or complete response after PRRT. Altogether, 115 patients were randomised 2:1 to an SSA group (n = 74) given octreotide acetate LAR every 4 weeks, or a control group (n = 41) receiving only best supportive care. Octreotide treatment was to stop upon intolerable toxicity or patient refusal, or, at physician/patient discretion, upon NEN progression. The primary endpoint was progression-free survival (PFS), the secondary endpoint, and overall survival (OS).

Results

Median (25th–75th percentile) follow-up from the first PRRT activity to death or latest observation was 6.6 (3.18–10.22) years. During that time, 71/115 patients (62%) progressed, 52/74 (70%) in the SSA group, and 19/41 (46%) in the control group (p = 0.01). Eighty-eight/115 patients (76%) died, 58/74 (78%) in the SSA group, and 30/41 (73%) in the control group (p = 0.52). Median (95% CI) PFS was 4.7 (2.8–7.7) years in the SSA group, and 6.4 (4.1–not reached) years in controls. Overall, median OS was 6.6 years. Neither PFS nor OS differed between groups (p = 0.129, p = 0.985, respectively).

Conclusions

In patients with disease control after PRRT, subsequent SSA treatment appeared not to be associated with better PFS or OS. Whether to continue SSA administration upon progression after PRRT requires evaluation in a prospective, randomised, controlled multicentre study with a relatively homogeneous sample.

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Title: In patients with well-differentiated neuroendocrine tumours, there is no apparent benefit of somatostatin analogues after disease control by peptide receptor radionuclide therapy
Authors: Aleksandra Syguła
Aleksandra Ledwon
Kornelia Hasse-Lazar
Beata Jurecka-Lubieniecka
Barbara Michalik
Ewa Paliczka-Cieślik
Marcin Zeman
Ewa Chmielik
Joanna Sczasny
Barbara Jarzab
Daria Handkiewicz-Junak
Publication date: 03-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Carcinoid Tumor
Radionuclide Therapy
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2022
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-022-05792-y

At a glance: The STEP trials

Springer Medicine

In patients with well-differentiated neuroendocrine tumours, there is no apparent benefit of somatostatin analogues after disease control by peptide receptor radionuclide therapy

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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