Results and adverse events of personalized peptide receptor radionuclide therapy with 90Yttrium and 177Lutetium in 1048 patients with neuroendocrine neoplasms
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Richard P. Baum1, Harshad R. Kulkarni1, Aviral Singh1, Daniel Kaemmerer2, Dirk Mueller1, Vikas Prasad3, Merten Hommann2, Franz C. Robiller4, Karin Niepsch1, Holger Franz5, Arthur Jochems6, Philippe Lambin6,7 and Dieter Hörsch8
1THERANOSTICS Center for Molecular Radiotherapy, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
2Department of General and Visceral Surgery, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
3Clinic for Nuclear Medicine, Charité, Berlin, Germany
4Center of Molecular Imaging, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
5Lohmann and Birkner, Berlin, Germany
6Department of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Hospital, Maastricht, The Netherlands
7Department of Radiation Oncology (The D-Lab), GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
8Department of Gastroenterology/Endocrinology, Center for Neuroendocrine Tumors Bad Berka – ENETS Center of Excellence, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
Dieter Hörsch, email: firstname.lastname@example.org
Keywords: peptide receptor radionuclide therapy; neuroendocrine tumors; survival; functional syndromes
Received: November 11, 2017 Accepted: February 01, 2018 Epub: February 15, 2018 Published: March 30, 2018
Introduction: Peptide receptor radionuclide therapy (PRRT) of patients with somatostatin receptor expressing neuroendocrine neoplasms has shown promising results in clinical trials and a recently published phase III study.
Methods: In our center, 2294 patients were screened between 2004 and 2014 by 68Ga somatostatin receptor (SSTR) PET/CT. Intention to treat analysis included 1048 patients, who received at least one cycle of 90Yttrium or 177Lutetium-based PRRT. Progression free survival was determined by 68Ga SSTR-PET/CT and EORTC response criteria. Adverse events were determined by CTCAE criteria.
Results: Overall survival (95% confidence interval) of all patients was 51 months (47.0-54.9) and differed significantly according to radionuclide, grading, previous therapies, primary site and functionality. Progression free survival (based on PET/CT) of all patients was 19 months (16.9-21), which was significantly influenced by radionuclide, grading, and origin of neuroendocrine neoplasm. Progression free survival after initial progression and first and second resumption of PRRT after therapy-free intervals of more than 6 months were 11 months (9.4-12.5) and 8 months (6.4-9.5), respectively. Myelodysplastic syndrome or leukemia developed in 22 patients (2.1%) and 5 patients required hemodialysis after treatment, other adverse events were rare.
Conclusion: PRRT is effective and overall survival is favorable in patients with neuroendocrine neoplasms depending on the radionuclide used for therapy, grading and origin of the neuroendocrine neoplasm which is not exactly mirrored in progression free survival as determined by highly sensitive 68Ga somatostatin receptor PET/CT using EORTC criteria for determining response to therapy.
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