Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-07-2015 | Short Communication

Towards tailored radiopeptide therapy

Authors: Piotr Radojewski, Rebecca Dumont, Nicolas Marincek, Philippe Brunner, Helmut R. Mäcke, Jan Müller-Brand, Matthias Briel, Martin A. Walter

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2015

Abstract

Purpose

Somatostatin receptor-targeted radiopeptide therapy is commonly performed using single radioisotopes. We evaluated the benefits and harms of combining radioisotopes in radiopeptide therapy in patients with neuroendocrine tumor.

Methods

Using multivariable-adjusted survival analyses and competing risk analyses we evaluated outcomes in patients with neuroendocrine tumor receiving ⁹⁰Y-DOTATOC, ¹⁷⁷Lu-DOTATOC or their combination.

Results

⁹⁰Y-DOTATOC plus ¹⁷⁷Lu-DOTATOC treatment was associated with longer survival than ⁹⁰Y-DOTATOC (66.1 vs. 47.5 months; n = 1,358; p < 0.001) or ¹⁷⁷Lu-DOTATOC alone (66.1 vs. 45.5 months; n = 390; p < 0.001). ¹⁷⁷Lu-DOTATOC was associated with longer survival than ⁹⁰Y-DOTATOC in patients with solitary lesions (HR 0.3, range 0.1 – 0.7; n = 153; p = 0.005), extrahepatic metastases (HR 0.5, range 0.3 – 0.9; n = 256; p = 0.029) and metastases with low uptake (HR 0.1, range 0.05 – 0.4; n = 113; p = 0.001). ⁹⁰Y-DOTATOC induced higher hematotoxicity rates than combined treatment (9.5 % vs. 4.0 %, p = 0.005) or ¹⁷⁷Lu-DOTATOC (9.5 % vs. 1.4 %, p = 0.002). Renal toxicity was similar among the treatments.

Conclusions

Using ⁹⁰Y and ¹⁷⁷Lu might facilitate tailoring radiopeptide therapy and improve survival in patients with neuroendocrine tumors.

Available only for authorised users

Imhof A, Brunner P, Marincek N, Briel M, Schindler C, Rasch H, et al. Response, survival, and long-term toxicity after therapy with the radiolabeled somatostatin analogue [90Y-DOTA]-TOC in metastasized neuroendocrine cancers. J Clin Oncol. 2011;29(17):2416–23. doi:10.1200/JCO.2010.33.7873.PubMedCrossRef

Cremonesi M, Ferrari M, Bodei L, Tosi G, Paganelli G. Dosimetry in peptide radionuclide receptor therapy: a review. J Nucl Med. 2006;47(9):1467–75.PubMed

De Jong M, Valkema R, Jamar F, Kvols LK, Kwekkeboom DJ, Breeman WA, et al. Somatostatin receptor-targeted radionuclide therapy of tumors: preclinical and clinical findings. Semin Nucl Med. 2002;32(2):133–40. doi:10.1053/snuc.2002.31027.PubMedCrossRef

Oyen WJ, Bodei L, Giammarile F, Maecke HR, Tennvall J, Luster M, et al. Targeted therapy in nuclear medicine – current status and future prospects. Ann Oncol. 2007;18(11):1782–92. doi:10.1093/annonc/mdm111.PubMedCrossRef

Villard L, Romer A, Marincek N, Brunner P, Koller MT, Schindler C, et al. Cohort study of somatostatin-based radiopeptide therapy with [(90)Y-DOTA]-TOC versus [(90)Y-DOTA]-TOC plus [(177)Lu-DOTA]-TOC in neuroendocrine cancers. J Clin Oncol. 2012;30(10):1100–6. doi:10.1200/JCO.2011.37.2151.PubMedCrossRef

Romer A, Seiler D, Marincek N, Brunner P, Koller MT, Ng QK, et al. Somatostatin-based radiopeptide therapy with [177Lu-DOTA]-TOC versus [90Y-DOTA]-TOC in neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2014;41(2):214–22. doi:10.1007/s00259-013-2559-8.PubMedCrossRef

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.PubMedCentralPubMedCrossRef

Bodei L, Cremonesi M, Ferrari M, Pacifici M, Grana CM, Bartolomei M, et al. Long-term evaluation of renal toxicity after peptide receptor radionuclide therapy with 90Y-DOTATOC and 177Lu-DOTATATE: the role of associated risk factors. Eur J Nucl Med Mol Imaging. 2008;35(10):1847–56. doi:10.1007/s00259-008-0778-1.PubMedCrossRef

Kashyap R, Jackson P, Hofman MS, Eu P, Beauregard JM, Zannino D, et al. Rapid blood clearance and lack of long-term renal toxicity of 177Lu-DOTATATE enables shortening of renoprotective amino acid infusion. Eur J Nucl Med Mol Imaging. 2013;40(12):1853–60. doi:10.1007/s00259-013-2504-x.PubMedCrossRef

10.

Sierra ML, Agazzi A, Bodei L, Pacifici M, Arico D, De Cicco C, et al. Lymphocytic toxicity in patients after peptide-receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE and 90Y-DOTATOC. Cancer Biother Radiopharm. 2009;24(6):659–65. doi:10.1089/cbr.2009.0641.PubMedCrossRef

Title: Towards tailored radiopeptide therapy
Authors: Piotr Radojewski
Rebecca Dumont
Nicolas Marincek
Philippe Brunner
Helmut R. Mäcke
Jan Müller-Brand
Matthias Briel
Martin A. Walter
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 8/2015
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3030-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Towards tailored radiopeptide therapy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2015

Role of perfusion SPECT in prediction and measurement of pulmonary complications after radiotherapy for lung cancer

Specific efficacy of peptide receptor radionuclide therapy with 177Lu-octreotate in advanced neuroendocrine tumours of the small intestine

Erratum to: 18F-Fluorocholine PET/CT for early response assessment in patients with metastatic castration-resistant prostate cancer treated with enzalutamide

Tumour targeting and radiation dose of radioimmunotherapy with 90Y-rituximab in CD20+ B-cell lymphoma as predicted by 89Zr-rituximab immuno-PET: impact of preloading with unlabelled rituximab

FDG PET/CT for bone and soft-tissue biopsy

V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism