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BMC Cancer
Published in: BMC Cancer 1/2019

Open Access 01-12-2019 | Cancer Biomarker | Research article

Peptide receptor radionuclide therapy in patients with medullary thyroid carcinoma: predictors and pitfalls

Authors: Carolien M. Beukhof, Tessa Brabander, Francien H. van Nederveen, Marie-Louise F. van Velthuysen, Yolanda B. de Rijke, Leo J. Hofland, Gaston J. H. Franssen, Lideke A. C. Fröberg, Boen L. R. Kam, W. Edward Visser, Wouter W. de Herder, Robin P. Peeters

Published in: BMC Cancer | Issue 1/2019

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Abstract

Background

For progressive metastatic medullary thyroid carcinoma (MTC), the available treatment options with tyrosine kinase inhibitors result in grade 3–4 adverse events in a large number of patients. Peptide Receptor Radionuclide Therapy (PRRT), which has also been suggested to be a useful treatment for MTC, is usually well tolerated, but evidence on its effectivity is very limited.

Methods

Retrospective evaluation of treatment effects of PRRT in a highly selected group of MTC patients, with progressive disease or refractory symptoms. In addition, a retrospective evaluation of uptake on historical 111In-DTPA-octreotide scans was performed in patients with detectable tumor size > 1 cm.

Results

Over the last 17 years, 10 MTC patients were treated with PRRT. Four out of 10 patients showed stable disease at first follow-up (8 months after start of therapy) whereas the other 6 were progressive. Patients with stable disease were characterized by a combination of both a high uptake on 111In-DTPA-octreotide scan (uptake grade ≥ 3) and a positive somatostatin receptor type 2a (SSTR2a) expression of the tumor by immunohistochemistry. Retrospective evaluation of historical 111In-DTPA-octreotide scans of 35 non-treated MTC patients revealed low uptake (uptake grade 1) in the vast majority of patients 31/35 (89%) with intermediate uptake (uptake grade 2) in the remaining 4/35 (11%).

Conclusions

PRRT using 177Lu-octreotate could be considered as a treatment in those patients with high uptake on 111In-DTPA-octreotide scan (uptake grade 3) and positive SSTR2a expression in tumor histology. Since this high uptake was present in a very limited number of patients, this treatment is only suitable in a selected group of MTC patients.
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Metadata
Title
Peptide receptor radionuclide therapy in patients with medullary thyroid carcinoma: predictors and pitfalls
Authors
Carolien M. Beukhof
Tessa Brabander
Francien H. van Nederveen
Marie-Louise F. van Velthuysen
Yolanda B. de Rijke
Leo J. Hofland
Gaston J. H. Franssen
Lideke A. C. Fröberg
Boen L. R. Kam
W. Edward Visser
Wouter W. de Herder
Robin P. Peeters
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2019
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-019-5540-5

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