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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Effectiveness of radiolabelled somatostatin analogs (90Y-DOTATOC and 177Lu-DOTAT...
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Vol. 36. Issue 3.
Pages 166-174 (May - June 2017)
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Vol. 36. Issue 3.
Pages 166-174 (May - June 2017)
Original Article
DOI: 10.1016/j.remnie.2017.01.007
Effectiveness of radiolabelled somatostatin analogs (90Y-DOTATOC and 177Lu-DOTATATE) in patients with metastatic neuroendocrine tumors: A single center experience in Mexico
Eficacia de los análogos de somatostatina radiomarcados (90Y-DOTATOC y 177Lu-DOTATATE) en pacientes con tumores neuroendocrinos metastásicos, experiencia de centro único en México
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S.S. Medina-Ornelas
,1
, F.O. García-Pérez1
Departamento de Medicina e Imagen Molecular, Instituto Nacional de Cancerología, Ciudad de México, Mexico
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Tables (3)
Table 1. Basal characteristics of the patients with neuroendocrine tumors (NET) (n=30).
Table 2. Basal characteristics of the patietns and results of patients with NET 3 months after the last PRRNT treatment (n=30). PR. Partial response; SD: stable disease; DP: disease progression.
Table 3. Overall response according to RECIST 1.1 criteria after at least one cycle of peptide receptor radionuclide therapy (PRRNT) and the correlation with a reduction in serum CgA levels.
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Abstract
Objective

To determine the effectiveness of therapy with the radiolabelled somatostatin analogs, 90Y-DOTATOC and 177Lu-DOTATATE, in the treatment of metastatic neuroendocrine tumors with progression to first-line treatment.

Material and methods

A study was conducted on 30 patients diagnosed with neuroendocrine tumors (gastroenteropancreatic, bronchopulmonary, MEN2A, MEN2B, phaeochromocytoma, and paraganglioma) with metastatic disease diagnosed by the pathology department, with progression to first-line treatment, and recruited from December 2014 to February 2016. Efficacy was analyzed using computed tomography (CT) according RECIST 1.1 criteria, and the molecular changes using the SUVmax of PET/CT with 68Ga-DOTATOC. Safety was carried out with a renal scan with 99mTc-MAG3.

Results

The 30 patients received a total of 49 cycles 90Y-DOTATOC (21 doses) and 177Lu-DOTATATE (28 doses), with a mean of 1.5 cycles per patient. Of these, 17 (56.7%) showed a partial morphological response, 22 (73.3%) molecular and biochemical response, and 23 (76.6%) clinical response. One patient died during the median follow-up of 13 months. The median overall survival from diagnosis was 54 months (95% CI; 31.18–76.81), and median progression-free survival was 32 months (95% CI; 15.00–48.99).

Conclusion

Therapy with 90Y-DOTATOC and 177Lu-DOTATATE is a promising therapy for patients with well and moderately differentiated neuroendocrine tumors. The efficacy is better the larger the number of cycles administered, inversely proportional to the number of metastases (<10), and is associated with the level of uptake according to the SUVmax by the metastases, regardless of metabolically active tumor volume.

Keywords:
Radiolabelled somatostatin analogs
Neuroendocrine tumors
90Y-DOTATOC
177Lu-DOTATATE
68Ga-DOTATOC PET/CT
Resumen
Objetivo

Determinar la eficacia de la terapia con análogos de somatostatina radiomarcados 90Y-DOTATOC y 177Lu-DOTATATE en el tratamiento de tumores neuroendocrinos metastásicos con progresión después de la primera línea de tratamiento.

Material y métodos

Se estudiaron 30 pacientes con el diagnóstico de tumor neuroendocrino (gastroenteropancreático, broncopulmonar, MEN2A, MEN2B, feocromocitoma y paraganglioma) con enfermedad metastásica diagnosticados por el departamento de patología, con progresión después de la primera línea de tratamiento, reclutados de diciembre del 2014 a febrero del 2016. La eficacia fue analizada usando la TC siguiendo los criterios RECIST 1.1 y los cambios moleculares en el SUVmáx de la PET/TC con 68Ga-DOTATOC. La seguridad fue valorada mediante el renograma con 99mTc-MAG3.

Resultados

Los 30 pacientes recibieron un total de 49 ciclos de 90Y-DOTATOC (21 dosis) y 177Lu-DOTATATE (28 dosis), con una media de 1,5 ciclos por paciente; 17 (56,7%) mostraron respuesta morfológica parcial; 22 (73,3%) respuesta molecular y bioquímica, y 23 (76,6%) respuesta clínica. Durante la mediana de seguimiento (13 meses) un paciente falleció (3,4%). La mediana de supervivencia global desde el diagnóstico fue de 54 meses (IC 95%, 31,18-76,81), y la mediana de supervivencia libre de progresión fue de 32 meses (IC 95%, 15,00-48,99).

Conclusión

El tratamiento con 90Y-DOTATOC y 177Lu-DOTATATE es una terapia prometedora para los pacientes con tumores neuroendocrinos bien y moderadamente diferenciados. La eficacia es proporcional al número de ciclos administrados, inversamente proporcional al número de metástasis (<10) y en relación con el grado de captación conforme al SUVmáx por parte de las metástasis, independientemente del volumen tumoral metabólicamente activo.

Palabras clave:
Análogos de somatostatina radiomarcados
Tumores neuroendocrinos
90Y-DOTATOC
177Lu-DOTATATE
68Ga-DOTATOC PET/TC

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