Safety and efficacy of re-treatment with [177Lu]Lu-DOTA-Octreotate radionuclide therapy in progressive gastro-entero-pancreatic neuroendocrine tumours – a single centre experience

IF 8.6 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Nuclear Medicine and Molecular Imaging Pub Date : 2025-03-26 DOI:10.1007/s00259-025-07235-w

Raghava Kashyap, Ramin Alipour, Emma Boehm, Kerry Jewell, Aravind S. RaviKumar, Anthony Cardin, Javad Saghebi, Michael S. Hofman, Michael T. Fahey, Michael Michael, Tim Akhurst, Rodney J. Hicks, Grace Kong

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引用次数: 0

Abstract

Aim

Patients with gastro-entero-pancreatic neuroendocrine tumours (GEP NET) who retain somatostatin receptor (SSTR) expression after initial response to [¹⁷⁷Lu]Lu-DOTA-Octreotate (LuTate) peptide receptor radionuclide therapy (PRRT) are amenable to re-treatment (R-PRRT) upon progression. We assessed the safety and efficacy of R-PRRT in patients with progressive metastatic GEP NET.

Materials and methods

A retrospective analysis, approved by institutional ethics board, was performed in patients with GEP NET who received R-PRRT for either symptomatically or radiologically progressive disease. Safety was assessed by renal and haematological parameters at 3 months post R-PRRT (CTCAE v5.0). Molecular imaging response was evaluated on [⁶⁸Ga]Ga-DOTA-Octreotate (GaTate) PET/CT using pre-defined criteria. RECIST 1.1 responses 3 months post R-PRRT were documented when feasible. Progression-free and overall survival analysis were performed.

Results

A total of 63 patients had R1-PRRT (1–3 cycles). The majority (70%) had Grade 2 NET and small intestinal primary (51%). A second re-treatment course (R2-PRRT) was given in 20 patients and a third course (R3-PRRT) in 6 patients. Glomerular filtration rate (GFR) was stable following R1-PRRT. Following R2-PRRT, worsening GFR from CTCAE G2 to G3 was seen in 10% (2/20) of patients, but none after R3-PRRT. Grade 3 thrombocytopenia occurred in 2 patients after R1-PRRT and in 1 patient after R3-PRRT. Grade 4 thrombocytopenia was observed in 1 patient post R1-PRRT. Following R1-PRRT, RECIST 1.1 responses CR, PR, SD was 0%, 10%, 76%, respectively. Disease control rate on GaTate PET/CT was 52/58 (89%) post R1-PRRT. Median progression free survival (PFS) following R1-PRRT was 1.6 years (95% CI:1.2–2.3).

Conclusion

R-PRRT is feasible, tolerable and efficacious in achieving disease control in patients with progressive GEP NET.

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目的胃肠道胰腺神经内分泌肿瘤（GEP NET）患者如果对[177Lu]Lu-DOTA-Octreotate（LuTate）肽受体放射性核素治疗（PRRT）初始反应后仍保留体生长抑素受体（SSTR）表达，则进展期患者可接受再治疗（R-PRRT）。我们对进展期转移性GEP NET患者接受R-PRRT治疗的安全性和有效性进行了评估。材料与方法我们对因症状或放射学进展性疾病接受R-PRRT治疗的GEP NET患者进行了回顾性分析，并获得了机构伦理委员会的批准。安全性通过R-PRRT术后3个月的肾脏和血液学参数进行评估（CTCAE v5.0）。分子影像学反应是通过[68Ga]Ga-DOTA-Octreotate（GaTate）PET/CT使用预先定义的标准进行评估的。在可行的情况下，记录 R-PRRT 术后 3 个月的 RECIST 1.1 反应。结果共有63名患者接受了R1-PRRT治疗（1-3个周期）。大多数患者（70%）为2级NET和小肠原发性NET（51%）。20名患者接受了第二个再治疗疗程（R2-PRRT），6名患者接受了第三个疗程（R3-PRRT）。R1-PRRT 治疗后，肾小球滤过率（GFR）保持稳定。R2-PRRT治疗后，10%（2/20）的患者GFR从CTCAE G2恶化到G3，但R3-PRRT治疗后没有出现这种情况。2 名患者在 R1-PRRT 后出现 3 级血小板减少，1 名患者在 R3-PRRT 后出现 3 级血小板减少。1例患者在R1-PRRT后出现4级血小板减少。R1-PRRT后，RECIST 1.1反应CR、PR、SD分别为0%、10%、76%。R1-PRRT后，GaTate PET/CT的疾病控制率为52/58（89%）。R1-PRRT 后的中位无进展生存期（PFS）为 1.6 年（95% CI：1.2-2.3）。

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来源期刊

European Journal of Nuclear Medicine and Molecular Imaging 医学-核医学

CiteScore

15.60

自引率

9.90%

发文量

392

审稿时长

3 months

期刊介绍： The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.