Abstract
Aim: The aim of this study is to correlate the uptake, residence time, and resulting mean absorbed dose in the kidneys with the posttherapy effect on renal function using the two most commonly used somatostatin analogs, 177Lu-DOTATATE and 177Lu-DOTATOC, during consecutive cycles of peptide receptor radionuclide therapy (PRRNT) in the same patient. Methods: 22 patients with metastatic neuroendocrine tumors underwent PRRNT with 177Lu-DOTATATE and 177Lu-DOTATOC. Dosimetry (MIRD scheme) was performed using OLINDA software. The patients were followed up for 6–12 months with serum creatinine, BUN, tubular extraction rate (TER) using 99mTc-MAG3, and glomerular filtration rate (GFR) using 99mTc-DTPA before and after therapy. Age, hypertension, and diabetes mellitus were the associated risk factors for renal toxicity, which were taken into account. Results: Uptake, residence time, and mean absorbed dose to the kidney were slightly, but significantly, higher for DOTATATE (actual absorbed dose 1.9–9.2 Gy) as compared with DOTATOC (dose 2.3–7.8 Gy) in 19 out of the 22 (86%) patients (p < 0.05). The tumor-to-kidney ratio was higher for DOTATOC in 23 out of 43 (53%) of the lesions analyzed; however, this difference was not statistically significant. There were no statistically significant changes in serum creatinine, BUN, TER or GFR pre and post-therapy with either DOTATATE or DOTATOC. Five of the 22 patients had mildly elevated serum creatinine after PRRNT, of whom 3 had history of hypertension, 1 had diabetes, and 1 was more than 65 years of age. Conclusions: 177Lu-DOTATATE and 177Lu-DOTATOC are safe radiopharmaceuticals concerning renal toxicity. 177Lu-DOTATOC delivers a slightly, but significantly, lower renal dose.
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References
Arora P, Verrelli M, Mulloy LL, Talavera F, Aronoff GR, Schmidt RJ, Batuman V. Chronic Renal failure. eMedicine Medscape references Feb 2012. http://emedicine.medscape.com/article/238798-overview
Behr TM, Goldenberg DM, Becker W (1998) Reducing the renal uptake of radiolabeled antibody fragments and peptides for diagnosis and therapy: present status, future prospects and limitations. Eur J Nucl Med 25:201–212
Bodei L, Cremonesi M, Zoboli S (2003) Receptor-mediated radionuclide therapy with 90Y-DOTATOC in association with amino acid infusion: a phase I study. Eur J Nucl Med 30:207–216
Bodei L, Cremonesi M, Ferrari M, Pacifi C, Grana C, Bartolomei M, Baio S, Sansovini M, Paganelli G (2008) Long-term evaluation of renal toxicity after peptide receptor radionuclide therapy with 90Y-DOTATOC and 177Lu-DOTATATE: the role of associated risk factors. Eur J Nucl Med 35(10):1847–1856
Bolch WE, Eckerman KF, Sgouros G, Thomas SR (2009) MIRD pamphlet No. 21: a generalized schema for radiopharmaceutical dosimetry–standardization of nomenclature. J Nucl Med 50:477–484
Cremonesi M, Ferrari M, Bodei L, Tosi G, Paganelli G (2006) Dosimetry in peptide radionuclide receptor therapy: a review. J Nucl Med 47(9):1467–1475
De Jong M, Bakker WH, Breeman WA et al (1998) Pre-clinical comparison of [DTPA0] octreotide, [DTPA0, Tyr3] octreotide and [DOTA0, Tyr3] octreotide as carriers for somatostatin receptor-targeted scintigraphy and radionuclide therapy. Int J Cancer 75:406–411
De Jong M, Valkema R, Jamar F (2002) Somatostatin receptor-targeted radionuclide therapy of tumors: preclinical and clinical findings. Semin Nucl Med 32:133
Esser JP, Krenning EP, Teunissen JJM (2006) Comparison of [177Lu-DOTA0, Tyr3] octreotate and [177Lu-DOTA0, Tyr3] octreotide: which peptide is preferable for PRRT? Eur J Nucl Med 33:1346–1351
Forrer F, Uusijärvi H, Waldherr C (2004) A comparison of 111In-DOTATOC and 111In-DOTATATE: biodistribution and dosimetry in the same patients with metastatic neuroendocrine tumours. Eur J Nucl Med 31:1257–1262
Helisch A, Förster GJ, Reber H (2004) Pre-therapeutic dosimetry and biodistribution of 86Y-DOTA-Phe1-Tyr3-octreotide versus 111In-pentetreotide in patients with advanced neuroendocrine tumours. Eur J Nucl Med 31:1386–1392
Jamar F, Barone R, Matthieu I et al (2003) 86Y-DOTA0-D-Phe1-Tyr3-octreotide (SMT487)—a phase 1 clinical study: pharmacokinetics, biodistribution and renal protective effect of different regiments of amino acid coinfusion. Eur J Nucl Med 30:510
Kwekkeboom DJ, Mueller-Brand J, Paganelli G (2005a) An overview of the results of peptide receptor radionuclide therapy with 3 different radiolabeled somatostatin analogues. J Nucl Med 46:62S
Kwekkeboom DJ, Teunissen JJ, Bakker WH et al (2005b) Radiolabeled somatostatin analog [177Lu-DOTA0, Tyr3]-octreotate in patients with endocrine gastroenteropancreatic tumors. J Clin Oncol 23:2754
Lambert B, Cybulla M, Weiner SM et al (2004) Renal toxicity after radionuclide therapy. Radiat Res 161:607–611
National Chronic Kidney Disease Fact Sheet (2010) CDC website. http://www.cdc.gov/diabetes/pubs/factsheets/kidney.htm
Otte A, Mueller-Brand J, Dellas S (1998) Yttrium-90 labeled somatostatin analogue for cancer treatment. Lancet 351:417
Pauwels S, Barone R, Walrand S et al (2005) Practical dosimetry of peptide receptor radionuclide therapy with 90Y-labeled somatostatin analogs. J Nucl Med 46(suppl 1):92S–98S
Valkema R, Pauwels SA, Kvols LK et al (2005) Long-term follow-up of renal function after peptide receptor radiation therapy with 90Y-DOTA0, Tyr3-octreotide and 177Lu-DOTA0, Tyr3-octreotate. J Nucl Med 46(suppl 1):83S–91S
Wehrmann C, Senftleben S, Zachert C, Mueller D, Baum RP (2007) Results of individual patient dosimetry in peptide receptor radionuclide therapy with 177Lu DOTA-TATE and 177Lu DOTA-NOC. Cancer Biother Radiopharm 22(3):406–416
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Kulkarni, H.R., Schuchardt, C., Baum, R.P. (2013). Peptide Receptor Radionuclide Therapy with 177Lu Labeled Somatostatin Analogs DOTATATE and DOTATOC: Contrasting Renal Dosimetry in the Same Patient. In: Baum, R., Rösch, F. (eds) Theranostics, Gallium-68, and Other Radionuclides. Recent Results in Cancer Research, vol 194. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27994-2_32
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