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Towards tailored radiopeptide therapy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Somatostatin receptor-targeted radiopeptide therapy is commonly performed using single radioisotopes. We evaluated the benefits and harms of combining radioisotopes in radiopeptide therapy in patients with neuroendocrine tumor.

Methods

Using multivariable-adjusted survival analyses and competing risk analyses we evaluated outcomes in patients with neuroendocrine tumor receiving 90Y-DOTATOC, 177Lu-DOTATOC or their combination.

Results

90Y-DOTATOC plus 177Lu-DOTATOC treatment was associated with longer survival than 90Y-DOTATOC (66.1 vs. 47.5 months; n = 1,358; p < 0.001) or 177Lu-DOTATOC alone (66.1 vs. 45.5 months; n = 390; p < 0.001). 177Lu-DOTATOC was associated with longer survival than 90Y-DOTATOC in patients with solitary lesions (HR 0.3, range 0.1 – 0.7; n = 153; p = 0.005), extrahepatic metastases (HR 0.5, range 0.3 – 0.9; n = 256; p = 0.029) and metastases with low uptake (HR 0.1, range 0.05 – 0.4; n = 113; p = 0.001). 90Y-DOTATOC induced higher hematotoxicity rates than combined treatment (9.5 % vs. 4.0 %, p = 0.005) or 177Lu-DOTATOC (9.5 % vs. 1.4 %, p = 0.002). Renal toxicity was similar among the treatments.

Conclusions

Using 90Y and 177Lu might facilitate tailoring radiopeptide therapy and improve survival in patients with neuroendocrine tumors.

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Acknowledgments

We are grateful to our nursing, laboratory and technical staff for their support in patient care, preparation of radiopharmaceuticals and acquisition of scans.

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all participants or their legal representatives.

Author information

Authors and Affiliations

  1. Institute of Nuclear Medicine, University Hospital Bern, 3010, Bern, Switzerland

    Piotr Radojewski, Nicolas Marincek & Martin A. Walter

  2. Institute of Nuclear Medicine, University Hospital Basel, Basel, Switzerland

    Rebecca Dumont, Nicolas Marincek, Philippe Brunner, Jan Müller-Brand & Martin A. Walter

  3. Department of Radiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Rebecca Dumont

  4. Division of Radiological Chemistry, University Hospital Basel, Basel, Switzerland

    Helmut R. Mäcke

  5. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland

    Matthias Briel

Authors
  1. Piotr Radojewski
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  2. Rebecca Dumont
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  3. Nicolas Marincek
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  4. Philippe Brunner
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  5. Helmut R. Mäcke
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  6. Jan Müller-Brand
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  7. Matthias Briel
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  8. Martin A. Walter
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Corresponding author

Correspondence to Martin A. Walter.

Additional information

Authors’ contributions

M.A.W. conceived of the study. P.R. designed the study. H.R.M. developed the test drug. J.M.B. administered the test drug. P.R., N.M., P.B., R.D. and M.B. collected and analyzed the data. P.R. and R.D. drafted the first manuscript. M.A.W. supervised study design, data collection, data analysis and writing of the final manuscript.

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Table S1

Predictors for Survival (n = 1499) (DOC 33 kb)

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Radojewski, P., Dumont, R., Marincek, N. et al. Towards tailored radiopeptide therapy. Eur J Nucl Med Mol Imaging 42, 1231–1237 (2015). https://doi.org/10.1007/s00259-015-3030-9

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  • DOI: https://doi.org/10.1007/s00259-015-3030-9

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