Somatostatin-based radiopeptide therapy with [177Lu-DOTA]-TOC versus [90Y-DOTA]-TOC in neuroendocrine tumours

  • A. Romer
  • D. Seiler
  • N. Marincek
  • P. Brunner
  • M. T. Koller
  • Q. K. T. Ng
  • H. R. Maecke
  • J. Müller-Brand
  • C. Rochlitz
  • M. Briel
  • C. Schindler
  • M. A. Walter
Original Article

DOI: 10.1007/s00259-013-2559-8

Cite this article as:
Romer, A., Seiler, D., Marincek, N. et al. Eur J Nucl Med Mol Imaging (2014) 41: 214. doi:10.1007/s00259-013-2559-8

Abstract

Purpose

Somatostatin-based radiopeptide treatment is generally performed using the β-emitting radionuclides 90Y or 177Lu. The present study aimed at comparing benefits and harms of both therapeutic approaches.

Methods

In a comparative cohort study, patients with advanced neuroendocrine tumours underwent repeated cycles of [90Y-DOTA]-TOC or [177Lu-DOTA]-TOC until progression of disease or permanent adverse events. Multivariable Cox regression and competing risks regression were employed to examine predictors of survival and adverse events for both treatment groups.

Results

Overall, 910 patients underwent 1,804 cycles of [90Y-DOTA]-TOC and 141 patients underwent 259 cycles of [177Lu-DOTA]-TOC. The median survival after [177Lu-DOTA]-TOC and after [90Y-DOTA]-TOC was comparable (45.5 months versus 35.9 months, hazard ratio 0.91, 95 % confidence interval 0.63–1.30, p = 0.49). Subgroup analyses revealed a significantly longer survival for [177Lu-DOTA]-TOC over [90Y-DOTA]-TOC in patients with low tumour uptake, solitary lesions and extra-hepatic lesions. The rate of severe transient haematotoxicities was lower after [177Lu-DOTA]-TOC treatment (1.4 vs 10.1 %, p = 0.001), while the rate of severe permanent renal toxicities was similar in both treatment groups (9.2 vs 7.8 %, p = 0.32).

Conclusion

The present results revealed no difference in median overall survival after [177Lu-DOTA]-TOC and [90Y-DOTA]-TOC. Furthermore, [177Lu-DOTA]-TOC was less haematotoxic than [90Y-DOTA]-TOC.

Keywords

YttriumLutetiumSomatostatinSurvivalNeuroendocrine tumour

Supplementary material

259_2013_2559_MOESM1_ESM.doc (52 kb)
Supplementary Table AHazard ratios for overall survival 1, 2 and 5 years after start of DOTA-TOC therapy (n=1051) (DOC 52 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • A. Romer
    • 1
  • D. Seiler
    • 1
  • N. Marincek
    • 1
    • 2
  • P. Brunner
    • 1
  • M. T. Koller
    • 3
  • Q. K. T. Ng
    • 1
  • H. R. Maecke
    • 4
  • J. Müller-Brand
    • 1
  • C. Rochlitz
    • 5
  • M. Briel
    • 2
    • 3
    • 6
  • C. Schindler
    • 7
  • M. A. Walter
    • 1
    • 2
  1. 1.Institute of Nuclear MedicineUniversity Hospital BaselBaselSwitzerland
  2. 2.Institute of Nuclear MedicineUniversity Hospital BernBernSwitzerland
  3. 3.Basel Institute for Clinical Epidemiology and BiostatisticsUniversity Hospital BaselBaselSwitzerland
  4. 4.Division of RadiochemistryUniversity Hospital BaselBaselSwitzerland
  5. 5.Department of OncologyUniversity Hospital BaselBaselSwitzerland
  6. 6.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  7. 7.Swiss Tropical and Public Health InstituteUniversity of BaselBaselSwitzerland