Personalized 177Lu-dotatate treatment of advanced P-NENs and the value of 18F-FDG PET-CT as a prognostic factor in a long term follow up: our experience.
Stefano SeveriMaddalena SansoviniAnnarita IannielloSilvia NicoliniA. AmbrosettiToni IbrahimMirco BartolomeiGiovanni Paganelli
2
Citation
0
Reference
20
Related Paper
Citation Trend
Abstract:
630 Objectives We evaluated long-term efficacy and toxicity of tailored 177Lu-dotatate (177Lu-PRRT) therapy in 65 consecutive patients with G1-G2 pancreatic neuroendocrine tumors (P-NENs).The role of 18F-FDG PET-CT as an independent prognostic factor was also investigated. Methods From March 2008 to September 2011, 65 consecutive P-NEN patients were enrolled in a prospective study and followed-up until March 2015. Patients were treated with two different total activities (18.5GBq or 27.8 GBq) and underwent 5 cycles of 177Lu-PRRT depending on the kidney and bone marrow status. Fifty-nine patients underwent 18F-FDG PET-CT before 177Lu-PRRT. Results Median follow-up was 59 months (7-82). Thirty patients received a mean full activity (FA) of 25.5 GBq (20.7-27.8) and 35 a mean reduced activity (RA) of 17.8 GBq (11.1-19.9). The disease control rate (DCR) in the FA group was 87% and 85% in the RA group (p=0.83). Median progression-free survival (PFS) was 53.4 months (21.2-68.7) in the FA arm and 24.4 months (19.5-59.2) in the RA arm (p= 0.42). Median overall survival (OS) was not reached in FA patients and was 63.8 months in the RA group (p= 0.013). No cases of grade 3 or 4 hematological toxicity were registered. One (3%) RA patient showed grade 2 renal toxicity and another (3%), grade 3 renal toxicity. Median PFS in the PET-CT-positive group was 21.2 months (18.9-28.7) compared to 68.7 months in PET-CT-negative patients (53.4-nr) (p Conclusions Personalized 177Lu-PRRT showed effective antitumor activity and mild toxicity in advanced P-NEN patients, and was feasible in patients with severe comorbidities. 18F-FDG PET-CT was confirmed as a valid independent prognostic factor in these patients.Keywords:
Radionuclide therapy
Cite
Progression-free survival
Autologous stem-cell transplantation
Standardized uptake value
Cite
Citations (1)
Cite
Citations (1)
ABVD
Dacarbazine
B symptoms
Hodgkin's lymphoma
Progression-free survival
Cite
Citations (4)
ABVD
B symptoms
Cite
Citations (0)
Lanreotide
Cite
Citations (32)
Cite
Citations (1)
Cite
Citations (18)
43 Objectives To evaluate the response to PRRT, using Y-90 or Lu-177 DOTA-TATE) and assess overall survival in patients with pNET. Methods 107 patients (mean age 60 yrs) of progressive pNET were treated with 1-7 cycles of PRRT using Y-90/Lu-177 DOTA-TATE. Response assessment (using Ga-68 DOTA-NOC PET/CT) was done in 54 patients receiving more than 3 cycles of PRRT and followed up for > 3 months. Results Mean/ Median duration of follow-up after first diagnosis (FD) was 107/58.5 months. 29/107 (27%) died. 26/107 (24%) had nonfunctional, 84/107 (76%) had functional pNET. Tumor localisation: head -31, body- 16, tail and cauda -41, total pancreas -4, body and tail -9 , head and body-. 11 patients had gastrinoma, 7 glucagonoma and 2 insulinoma. Metastases in liver was present in 99/107 (92.5%), lymph node 58/107 (54%) and in bone 38/107 (36.4%). The patients were pretreated with chemotherapy-44/107 (41%), surgery 52/107 (48.6%) and biotherapy (octreotide) 46/107 (43%). Objective response was seen in 52% of the patients, 39% had SD and 9% had PD. Median duration of survival from FD was 189 months. Median survival in patients with pNET in head (132 months) was less than that in body/cauda/tail (256 months). Mean survival in nonfunctional pNET was 148 months as compared to 341 months for functional pNET. Mean survival in patients with Ki 67 20%. Conclusions PRRT is an effective therapy option for pNET. Patients with pNET in head of pancreas and high grade tumor (Ki67 > 20%) have the worst prognosis.
Radionuclide therapy
DOTA
Cite
Citations (9)
To evaluate the image of SPECT/PET (18)F-FDG in monitoring response to therapy for lymphoma patients.A retrospective study was performed in 83 SPECT/PET studies for 70 patients with lymphoma from 1998 to 2008 in our hospital. The risk factors for survival rate were analyzed by univariate analysis.Forty patients received SPECT/PET after 2 - 4 cycles of chemotheraphy, the median PFS in patients with positive and negative group were 5.5 months and 15.5 months, 2-year PFS were 12.5% and 66.8%; the median OS were 12.5 months and 17 months, and 1-year OS were 28.8% and 94.1%, respectively, all being of significant difference between two groups (P = 0.003). Forty-three patients performed posttreatment SPECT/PET, the median PFS in patients with positive and negative group were 10 months and 23 months, the 2-year PFS were 23.3% and 83.2%; the median OS were 17 months and 27 months and the 2-year OS were 60.0% and 100% respectively, all being of significant difference (P = 0.001).SPECT/PET has significant value in monitoring response to therapy and predicting prognosis for patients with lymphoma.
Univariate analysis
Cite
Citations (1)
Neuroendocrine tumors (NETs) are a diverse group of tumors that often present late due to nonspecific symptoms. These tumors frequently express somatostatin receptors (SSRs), which allows for positron emission tomography/computed tomography (PET/CT) imaging with Ga-68-DOTATATE. In eligible patients, this may then be followed by peptide receptor radionuclide therapy (PRRT). Here, we report our initial results and experience with PRRT in a developing country, as one of the first groups to provide this therapy in South Africa. Eligible patients with confirmed inoperable NETs were recruited prospectively and treated with Lu-177-DOTATATE. Baseline imaging was performed with either single-photon emission CT- or PET-based SSR analogs, whereas follow-up was performed with 68Ga-DOTATATE PET/CT 6 months post treatment completion. Interim treatment response evaluation was based on post therapy imaging of Lu-177-DOTATATE. A total of 48 patients with a mean age of 58 years were treated with PRRT, of whom 22 (46%) demonstrated stable disease, 20 (42%) demonstrated a partial response, and 6 (12%) demonstrated progressive disease. The median progression-free survival (PFS) was 20 months with an interquartile range (IQR)25%-75% of 4.5-30 months. The median freedom from progression duration was 32 months with an IQR25%-75% of 25-40 months, and the median overall survival was 10 months with an (IQR)25%-75% of 5-24 months. Our subgroup analysis demonstrated an inverse association between metabolic tumor volume with PFS, which requires further validation. In conclusion, PRRT with Lu-177-DOTATATE resulted in a median PFS of 20 months in patients with inoperable NETs in the absence of significant side effects.
Radionuclide therapy
Interquartile range
Cite
Citations (4)