The South Australian 177Lu-DOTATATE peptide receptor radionuclide therapy service: an 11-year review of toxicity, health-related quality of life, and survival

Abstract

Background

The aim of this study was to audit clinical and patient-reported outcomes of patients treated with [¹⁷⁷Lu]-DOTA-octreotate (¹⁷⁷Lu-DOTATATE) at a single Australian centre over an 11-year period.

Methods

A retrospective analysis of 189 patients with metastatic or locally advanced neuroendocrine neoplasms or tumours (NENs/NETs) or other somatostatin receptor-positive tumour treated with ¹⁷⁷Lu-DOTATATE at The Queen Elizabeth Hospital from 2011 to 2022 was carried out. Toxicity, radiological response, health-related quality of life (hr-QoL), and overall survival (OS) were summarised.

Results

Gastroenteropancreatic (NET) origin accounted for 75% of cases. The median age of diagnosis was 59 years and median age at first cycle of ¹⁷⁷Lu-DOTATATE at The Queen Elizabeth Hospital was 64.7 years (range 16.5-92.6 years). Of the 182 patients who commenced induction peptide receptor radionuclide therapy (iPRRT), 143 (79%) completed four or five induction cycles. There were 52 patients who received retreatment PRRT (rPRRT). When radiological response was assessed following completion of a full iPRRT course (≥four cycles, 131 patients), radiologically stable disease was seen in 76% of patients. A completed hr-QoL questionnaire was available for 760 cycles (92%). Significant improvements were found across multiple domains after iPRRT. Eight patients (4.2%) developed a haematological malignancy. Renal function declined at long-term but not short-term follow-up. Median duration of follow-up was 37.6 months (range 0.0-134.6 months) with a median OS from first cycle of PRRT 48.4 months (95% confidence interval 42.5-57.3 months).

Conclusion

Patients with advanced NEN/NET or other somatostatin receptor-positive malignancies treated with ¹⁷⁷Lu-DOTATATE at our centre had improved hr-QoL following iPRRT, with comparable toxicity and OS to other centres.