Phase II study of radiopeptide 177Lu-octreotate and capecitabine therapy of progressive disseminated neuroendocrine tumours
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In this phase II study we investigated the safety and efficacy of combination capecitabine and 177Lu-octreotate for the treatment of disseminated, progressive, unresectable neuroendocrine tumours (NETs).
Enrolled in the study were 33 patients with biopsy-proven NETs, positive 111In-octreotide scintigraphy and progressive disease measurable by CT/MRI who were to receive four cycles of 7.8 GBq 177Lu-octreotate 8-weekly, with 14 days of 1,650 mg/m2 capecitabine per day.
Of the 33 patients, 25 completed four cycles. Minimal transient myelosuppression at 3–4 weeks caused grade 3 thrombocytopenia in one patient but no neutropenia. Nephrotoxicity was absent. Critical organ radiation dosimetry provided median estimates of the dose per cycle to the kidneys of 2.4 Gy and to the liver of 4.8 Gy, and showed cumulative doses all below toxic thresholds. Objective response rates (ORR) were 24% partial response (PR), 70% stable disease (SD) and 6% progressive disease. Median progression-free survival and median overall survival had not been reached at a median follow-up of 16 months (range 5–33 months). Survival at 1 and 2 years was 91% (95% CI 75–98%) and 88% (95% CI 71–96%), respectively.
The addition of capecitabine radiosensitizing chemotherapy does not increase the minimal toxicity of 177Lu-octreotate radiopeptide therapy and led to an ORR of 24% PR and 70% minor response or SD in patients with progressive metastatic NETs. Tumour control and stabilization of disease was obtained in 94% of these patients.
KeywordsNeuroendocrine tumours Radiopeptide Capecitabine 177Lu-octreotate
The kind personal donation of octreotate peptide by Professor Eric Krenning, Erasmus Medical Centre, Rotterdam, The Netherlands, is gratefully acknowledged. The authors also wish to thank Ms. Anna Chiam for clinical data management, Ms. Suet Mei Yu for statistical analysis and Ms. Jenny Lavin for preparation of the manuscript. The chromogranin A assays were kindly performed by Ms. Zoe Inman and Ms. Nikki Orridge. Clinical data management was funded by the WA Cancer and Palliative Care Network. This was a physician-sponsored study approved by the Human Research Ethics Committee of Fremantle Hospital and Health Service.
Conflicts of interest
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