Efficacy and Safety of 177Lu-DOTATATE in Lung Neuroendocrine Tumors: A Bicenter study
Details
Publication Year 2022-02,Volume 63,Issue #2,Page 218-225
Journal Title
Journal of Nuclear Medicine
Publication Type
Research article
Abstract
The purpose of this study was to assess the efficacy and safety of (177)Lu-DOTATATE in patients with somatostatin receptor (SSR)-positive lung neuroendocrine tumors (NETs). Methods: This is a retrospective review of the outcome of patients with typical carcinoid (TC) and atypical carcinoid (AC), treated with (177)Lu-DOTATATE at 2 ENETS Centers of Excellence. Morphologic imaging (RECIST 1.1) and (68)Ga-DOTATATE PET/CT responses were assessed at 3 mo after completion of (177)Lu-DOTATATE. Concordance between 2 response assessment methods was evaluated by kappa statistics. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier analysis and compared by Log-rank test. Treatment-related adverse events (AEs) were graded based on Common Terminology Criteria for Adverse Events, version 5. Results: Of 48 patients (median age, 63 y; 13 women), 43 (90%) had AC and 5 (10%) TC. Almost all patients (47, 98%) were treated due to progression. Most patients (40, 83%) received somatostatin analogs, and 10 patients (20%) had prior everolimus, chemotherapy, or both. All patients had high SSR expression (>/= modified Krenning score 3) on pretreatment (68)Ga-DOTATATE PET/CT. Patients received a median 4 (range, 1-4) cycles of (177)Lu-DOTATATE (33% with concurrent radiosensitizing chemotherapy) to a median cumulative activity of 27 GBq (range, 6-43GBq). At a median follow-up of 42 mo, the median PFS and OS were 23 mo (95% CI, 18-28 mo) and 59 mo (95% CI, 50-not reached [NR]), respectively. Of 40 patients with RECIST-measurable disease and 39 patients with available (68)Ga-DOTATATE PET/CT, response categories were partial response, 20% (95% CI, 10%-35%) and 44% (95% CI, 30%-59%); stable disease, 68% (95% CI, 52%-80%) and 44% (95% CI, 30%-59%); and progressive disease, 12% (95% CI, 5%-27%) by both, respectively. There was a moderate concordance between response categories by RECIST and (68)Ga-DOTATATE PET/CT, weighted kappa of 0.51 (95% CI, 0.21-0.68). Of patients with stable disease by RECIST, those with partial response on (68)Ga-DOTATATE PET/CT had a longer OS than those with no response, NR versus 52 mo (95% CI, 28-64), hazard ratio 0.2 (95% CI, 0.1-0.6), P < 0.001. Most grade 3/4 AEs were reversible and the most common was lymphopenia (14%) with no incidence of myelodysplasia or leukemia. Conclusion: In patients with advanced progressive lung NET and satisfactory SSR expression, (177)Lu-DOTATATE is effective and safe with a high disease control rate and encouraging PFS and OS.
Keywords
Adult; Aged; Aged, 80 and over; Female; Humans; Lung Neoplasms/diagnostic imaging/mortality/*radiotherapy; Male; Middle Aged; Neuroendocrine Tumors/diagnostic imaging/mortality/*radiotherapy; Octreotide/adverse effects/*analogs & derivatives/therapeutic use; Organometallic Compounds/adverse effects/*therapeutic use; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals/*therapeutic use; Retrospective Studies; bronchial carcinoid; lung neuroendocrine tumor; peptide receptor radionuclide therapy; somatostatin receptor
Department(s)
Cancer Imaging; Medical Oncology
PubMed ID
34049983
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