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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) 177Lu-DOTATATE treatment in neuroendocrine tumors. A preliminary study
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Vol. 36. Issue 2.
Pages 91-98 (March - April 2017)
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Vol. 36. Issue 2.
Pages 91-98 (March - April 2017)
Original Article
177Lu-DOTATATE treatment in neuroendocrine tumors. A preliminary study
Tratamiento con 177LU-DOTATATE en tumores neuroendocrinos. Estudio preliminar
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I. Herv??sa,
Corresponding author
hervas_isaben@gva.es

Corresponding author.
, P. Belloa, M. Falgasa, M.I. del Olmob, I. Torresa, C. Olivasa, V. Veraa, P. Oliv??na, A.M. Yepesa
a Servicio de Medicina Nuclear, Hospital Universitario La Fe, Valencia, Spain
b Servicio de Endocrinolog??a, Hospital Universitario La Fe, Valencia, Spain
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Table 1. Demographic data of the patients, tumor types, presence of bone and hepatic metastases (mtx.), main symptomatology, Karnofsky performance scale (KPS), somatostatin receptor scintigraphy (SRS) and tumor markers prior to treatment with 177Lu-DOTATATE.
Table 2. Karnofsky performance scale.
Table 3. Biochemical response, response based on the imaging techniques and functional response of the 7 patients treated in our hospital.
Table 4. Toxicity of each patient receiving treatment with 177Lu-DOTATATE.
Table 5. Response to treatment observed in the literature.
Table 6. Adverse effects observed in several of the most relevant studies on therapy with 177Lu-DOTATATE.
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Abstract

Therapy with radiolabelled somatostatin analog peptides is a promising new therapy to treat neuroendocrine tumors. The aim of this preliminary study is to present our experience with 177Lu-DOTATATE therapy, and evaluate tolerability and short-term efficacy in patients with tumors expressing somatostatin receptors. A total of 7 patients with metastatic neuroendocrine tumors were treated, each with 4 doses of 177Lu-DOTATATE. The treatment response was evaluated in the form of biochemical response (tumor markers), imaging methods (somatostatin receptor scintigraphy, computed tomography, and magnetic resonance), and functional and quality of life responses using the Karnofsky performance status scale. Treatment toxicity was also evaluated. The results obtained were as follows: Biochemical response: 60% of patients showed tumor marker levels returning to normal, while they decreased significantly in the remaining 40%. Imaging response: 85.7% had a partial response, while 14.3% showed stable disease. All (100%) patients showed a significant improvement in quality of life, with increased Karnofsky scale scores. No patient had acute or chronic toxicity, and subacute transient hematological toxicity was observed in 42.8% of patients. Despite being a preliminary study, it was found that treatment with 177Lu-DOTATATE is a safe treatment with few side effects, and an objective response was achieved in most patients.

Keywords:
Neuroendocrine tumors
Radionuclide therapy
177Lu-DOTATATE
Resumen

La terapia con péptidos análogos de la somatostatina marcados con radionúclidos es un nuevo tratamiento prometedor para tratar tumores neuroendocrinos. El objetivo del presente estudio preliminar es presentar nuestra experiencia en la terapia con 177Lu-DOTATATE y evaluar la tolerabilidad y la eficacia a corto plazo en pacientes con tumores que expresan receptores para la somatostatina. Se han tratado 7 pacientes con tumores neuroendocrinos metastásicos, cada uno con 4 dosis de 177Lu-DOTATATE y se ha evaluado su respuesta al tratamiento en forma de respuesta bioquímica (marcadores tumorales y analítica), según métodos de imagen (gammagrafía de receptores de somatostatina, tomografía computarizada y resonancia magnética) y respuesta funcional y de calidad de vida (mediante la Escala de actividad de Karnofsky). Se ha evaluado también la toxicidad del tratamiento. Los resultados obtenidos han sido los siguientes: respuesta bioquímica: el 60% de los pacientes mostraron una normalización de sus niveles de marcadores tumorales, mientras que en el 40% disminuyeron de manera significativa; respuesta en técnicas de imagen: el 85,7% presentaron una respuesta parcial, mientras que el 14,3% mostraron enfermedad estable; mejoría de la calidad de vida: el 100% de los pacientes mostraron una mejoría significativa en la calidad de vida con un incremento de la Escala de actividad de Karnofsky, y en cuanto a la toxicidad: ningún paciente presentó toxicidad aguda o crónica, y el 42,8% de los pacientes presentaron toxicidad subaguda hematológica transitoria. A pesar de tratarse de un estudio preliminar podemos afirmar que el tratamiento con 177Lu-DOTATATE es un tratamiento seguro, con pocos efectos adversos y que consigue una respuesta objetiva en la mayoría de los pacientes.

Palabras clave:
Tumores neuroendocrinos
Terapia con radion??clidos
177Lu-DOTATATE

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