Treatment With the Radiolabeled Somatostatin Analog [177Lu-DOTA0,Tyr3]Octreotate: Toxicity, Efficacy, and Survival

American Society of Clinical Oncology (ASCO) - Tập 26 Số 13 - Trang 2124-2130 - 2008
Dik J. Kwekkeboom1, Wouter W. de Herder2, Boen L.R. Kam2, Casper H.J. van Eijck2, Marc van Essen2, P.P.M. Kooij2, Richard A. Feelders2, Maarten O. van Aken2, Eric P. Krenning2
1Department of Nuclear Medicine, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. [email protected]
2From the Departments of Nuclear Medicine, Internal Medicine, and Surgery, Erasmus Medical Center, Rotterdam, the Netherlands

Tóm tắt

Purpose Despite the fact that most gastroenteropancreatic neuroendocrine tumors (GEPNETs) are slow-growing, median overall survival (OS) in patients with liver metastases is 2 to 4 years. In metastatic disease, cytoreductive therapeutic options are limited. A relatively new therapy is peptide receptor radionuclide therapy with the radiolabeled somatostatin analog [177Lu-DOTA0,Tyr3]octreotate. Here we report on the toxicity and efficacy of this treatment, performed in over 500 patients. Patients and Methods Patients were treated up to a cumulative dose of 750 to 800 mCi (27.8-29.6 GBq), usually in four treatment cycles, with treatment intervals of 6 to 10 weeks. Toxicity analysis was done in 504 patients, and efficacy analysis in 310 patients. Results Any hematologic toxicity grade 3 or 4 occurred after 3.6% of administrations. Serious adverse events that were likely attributable to the treatment were myelodysplastic syndrome in three patients, and temporary, nonfatal, liver toxicity in two patients. Complete and partial tumor remissions occurred in 2% and 28% of 310 GEPNET patients, respectively. Minor tumor response (decrease in size > 25% and < 50%) occurred in 16%. Median time to progression was 40 months. Median OS from start of treatment was 46 months, median OS from diagnosis was 128 months. Compared with historical controls, there was a survival benefit of 40 to 72 months from diagnosis. Conclusion Treatment with [177Lu-DOTA0,Tyr3]octreotate has few adverse effects. Tumor response rates and progression-free survival compare favorably to the limited number of alternative treatment modalities. Compared with historical controls, there is a benefit in OS from time of diagnosis of several years.

Từ khóa


Tài liệu tham khảo

10.1038/bjc.1994.424

10.1002/1097-0142(19950701)76:1<106::AID-CNCR2820760116>3.0.CO;2-W

10.1023/A:1007334217762

10.1054/bjoc.2000.1394

10.1023/A:1012272314550

10.1002/1097-0142(20011015)92:8<2204::AID-CNCR1564>3.0.CO;2-R

10.1136/gut.2003.026401

10.1002/cncr.11105

10.1007/s10620-006-9345-4

10.1023/A:1008215730767

10.1016/j.surg.2007.01.036

10.1007/BF02557521

10.1002/cncr.21389

10.2214/AJR.06.0933

10.1200/JCO.2005.08.066

10.1007/s002590100574

10.1007/BF00944177

10.1007/s002590050476

Waldherr C, Pless M, Maecke HR, et al: Tumor response and clinical benefit in neuroendocrine tumors after 7.4 GBq (90)Y-DOTATOC. J Nucl Med 43:610,2002-616,

Valkema R, Pauwels SA, Kvols LK, et al: Long-term follow-up of renal function after peptide receptor radiation therapy with (90)Y-DOTA(0),Tyr(3)-octreotide and (177)Lu-DOTA(0), Tyr(3)-octreotate. J Nucl Med 46: Suppl 1:83S,2005–91S,

10.1002/(SICI)1097-0142(19990915)86:6<944::AID-CNCR8>3.0.CO;2-P

10.1002/1097-0142(19940301)73:5<1505::AID-CNCR2820730530>3.0.CO;2-V

Ritzel U, Leonhardt U, Stockmann F, et al: Treatment of metastasized midgut carcinoids with dacarbazine. Am J Gastroenterol 90:627,1995-631,

10.1200/JCO.1995.13.6.1486

10.1038/bjc.1995.21

10.1002/1097-0142(20010415)91:8<1543::AID-CNCR1163>3.0.CO;2-N

10.1200/jco.2004.22.14_suppl.4762

10.1200/JCO.2005.03.616

10.1159/000093004

10.1007/s00280-006-0306-6

10.1159/000201081

10.3109/02841869309083916

10.1111/j.1572-0241.2000.03210.x

10.1159/000080746

10.1038/sj.bjc.6603526

10.1023/A:1011160913619

10.1007/s00259-002-1023-y

Waldherr C, Schumacher T, Maecke HR, et al: Does tumor response depend on the number of treatment sessions at constant injected dose using 90Yttrium-DOTATOC in neuroendocrine tumors? Eur J Nucl Med 29:S100,2002, (suppl abstr)

10.1053/j.semnuclmed.2006.01.001

10.1007/s00259-006-0172-9

10.1159/000098013

Thông tin
Thông tin xuất bản

American Society of Clinical Oncology (ASCO)

Tập 26 Số 13

2124-2130

Thông tin tác giả