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High clinical and morphologic response using 90Y-DOTA-octreotate sequenced with 177Lu-DOTA-octreotate induction peptide receptor chemoradionuclide therapy (PRCRT) for bulky neuroendocrine tumours

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Abstract

Purpose

Bulky disease is an adverse prognostic factor for 177Lu-DOTA-octreotate (177Lu-DOTATATE) peptide receptor radionuclide therapy (PRRT). 90Y-DOTA-octreotate (90Y-DOTATATE) has theoretical advantages in this setting but may less effectively treat co-existent smaller deposits and have higher toxicity than 177Lu-DOTATATE. The aim of this study was to assess the efficacy and safety of using these agents sequentially.

Methods

We reviewed patients (pts) with at least one lesion of a transaxial diameter >4 cm who completed 1–2 cycles of 90Y-DOTATATE followed by 2–3 cycles of 177Lu-DOTATATE, with treatment empirically adapted to disease size and burden in individual patients. Data collected included morphological and molecular imaging response, toxicity, and progression-free and overall survival.

Results

Twenty-six pts (17 men; aged 27–74 years) received a median cumulative activity of 6.5 GBq 90Y-DOTATATE, and 21 GBq 177Lu-DOTATATE. All but one received radiosensitising chemotherapy. Adverse prognostic factors included ENETS grade 2 or 3 in 58 %, and FDG-avid disease in 73 %. Nineteen pts treated for progressive disease had stabilisation (37 %) or regression on CT (42 % partial response, 21 % minor response), with a mean 59 % (8–99 %) reduction in disease burden. All seven pts treated for uncontrolled symptoms reported improvement during PRRT with 4/7 having complete symptom resolution at 3 months. Eight patients had grade 3/4 lymphopaenia, and two patients grade 3/4 thrombocytopaenia without significant hepatic or renal toxicity. Median survival was not reached after a median follow-up of 35 months. Median progression-free survival was 33 months.

Conclusion

PRCRT with 90Y -DOTATATE followed by 177Lu-DOTATATE in individualised regimens achieved high clinical and morphological response in patients with bulky tumours. Despite lack of a control arm, the efficacy of this treatment approach appears higher than reported results with either agent used alone or other approved treatments, particularly given the adverse prognostic features of this cohort.

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Acknowledgments

Professor Hicks is supported by a National Health and Medical Research Council of Australia practitioner fellowship and program grant. The authors would like to thank our excellent team of nuclear medicine technologists and radionuclide therapy nurses for their care of our patients.

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Authors and Affiliations

  1. Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Grace Kong, Jason Callahan, Michael S. Hofman, David A. Pattison, Tim Akhurst, Peter Eu & Rodney J. Hicks

  2. Department of Medicine, The University of Melbourne, Parkville, Australia

    Michael S. Hofman

  3. Division of Cancer Medicine, Neuroendocrine Tumour Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Michael Michael

  4. The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia

    Michael Michael & Rodney J. Hicks

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  1. Grace Kong
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  2. Jason Callahan
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  5. Tim Akhurst
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  6. Michael Michael
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  8. Rodney J. Hicks
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Correspondence to Grace Kong or Rodney J. Hicks.

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All authors declare no conflicts of interest. All procedures performed were in accordance with the ethical standards of the institutional research committee and all patients provided informed consent for treatment.

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Kong, G., Callahan, J., Hofman, M.S. et al. High clinical and morphologic response using 90Y-DOTA-octreotate sequenced with 177Lu-DOTA-octreotate induction peptide receptor chemoradionuclide therapy (PRCRT) for bulky neuroendocrine tumours. Eur J Nucl Med Mol Imaging 44, 476–489 (2017). https://doi.org/10.1007/s00259-016-3527-x

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