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Long-term results of PRRT in advanced bronchopulmonary carcinoid

  • Annapaola Mariniello
  • Lisa Bodei
  • Carmine Tinelli
  • Silvia Melania Baio
  • Laura Gilardi
  • Marzia Colandrea
  • Stefano Papi
  • Giuseppe Valmadre
  • Nicola Fazio
  • Domenico Galetta
  • Giovanni Paganelli
  • Chiara Maria Grana
Original Article

Abstract

Purpose

Peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumours (NET) has been explored for almost two decades, but there are still few trials that have exclusively investigated well-differentiated and moderately differentiated NET arising from the respiratory tree. Thus, the aim of this study was to explore the outcome in patients affected by bronchopulmonary carcinoid (BPC) following PRRT.

Methods

We retrospectively analysed 114 patients with advanced stage BPC consecutively treated with PRRT at the European Institute of Oncology, Milan, from 1997 to 2012 and followed until October 2014. The objective responses, overall survival (OS) and progression-free survival (PFS) were rated, and three different PRRT protocols (90Y-DOTATOC vs. 177Lu-DOTATATE vs. 90Y-DOTATOC + 177Lu-DOTATATE) were compared with regard to their efficacy and tolerability.

Results

The median OS (evaluated in 94 of the 114 patients) was 58.8 months. The median PFS was 28.0 months. The 177Lu-DOTATATE protocol resulted in the highest 5-year OS (61.4 %). Morphological responses (partial responses + minor responses) were obtained in 26.5 % of the cohort and were associated with longer OS and PFS. The 90Y-DOTATOC + 177Lu-DOTATATE protocol provided the highest response rate (38.1 %). Adverse events were mild in the majority of patients. However, haematological toxicity negatively affected survival. No severe (grade 3/4) serum creatinine increase was observed. Patients treated with 90Y-DOTATOC alone more frequently showed a mild/moderate decrease in renal function. In patients treated with chemotherapy before PRRT had a shorter OS and PFS, and a higher risk of developing nephrotoxicity.

Conclusion

In a large cohort of patients with advanced BPC treated in a “real-world” scenario and followed up for a median of 45.1 months (range 2 – 191 months), PRRT proved to be promising in prolonging survival and delaying disease progression. Despite the potential selection biases, considering the risk-benefit ratio, 177Lu-DOTATATE monotherapy seems the best option for PRRT. Our results indicate that the use of PRRT in earlier stages of the disease could provide a more favorable outcome.

Keywords

Peptide receptor radionuclide therapy Neuroendocrine tumours Bronchopulmonary carcinoid 

Notes

Compliance with ethical standards

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/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not describe any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Annapaola Mariniello
    • 1
  • Lisa Bodei
    • 1
  • Carmine Tinelli
    • 2
  • Silvia Melania Baio
    • 1
  • Laura Gilardi
    • 1
  • Marzia Colandrea
    • 1
  • Stefano Papi
    • 1
  • Giuseppe Valmadre
    • 3
  • Nicola Fazio
    • 4
  • Domenico Galetta
    • 5
  • Giovanni Paganelli
    • 6
  • Chiara Maria Grana
    • 1
  1. 1.Division of Nuclear MedicineEuropean Institute of OncologyMilanItaly
  2. 2.Epidemiology and Biometric UnitIRCCS Foundation Policlinico San MatteoPaviaItaly
  3. 3.Presidio Ospedaliero E. Morelli AOVVSondaloItaly
  4. 4.Unit of Gastrointestinal Medical Oncology and Neuroendocrine TumorsEuropean Institute of OncologyMilanItaly
  5. 5.Thoracic Surgery DivisionEuropean Institute of OncologyMilanItaly
  6. 6.Nuclear Medicine and Radiometabolic UnitsIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly

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