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Outcome and toxicity of salvage therapy with 177Lu-octreotate in patients with metastatic gastroenteropancreatic neuroendocrine tumours

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Abstract

Purpose

We assessed the outcome and toxicity of salvage therapy (repeat treatment) with 177Lu-octreotate and high cumulative activities in patients with metastatic gastroenteropancreatic neuroendocrine tumours (GEP-NET).

Methods

We retrospectively analysed a consecutive cohort of 33 patients with metastatic GEP-NET who underwent salvage peptide receptor radionuclide therapy (PRRT) in our institution. All patients had progressive NET prior to salvage treatment and had shown an initial response to PRRT. The mean cumulative activity was 44.3 GBq (30.0–83.7 GBq). Radiographic response was assessed using CT and/or MRI according to modified SWOG criteria. Toxicity was evaluated using laboratory data, including complete blood counts and renal function tests using CTCAE 3.0. Survival analysis was performed with the Kaplan-Meier curve method and a significance level at p < 0.05.

Results

Radiographic responses consisted of complete response in 1 patient (3.0 %), partial response in 6 patients (18.2 %), minor response in 1 patient (3.0 %), stable disease in 14 patients (42.4 %), and progressive disease in 11 patients (33.3 %). Median progression-free survival (PFS) from the start of salvage therapy was 13 months (95 % CI 9–18) and patients with a history of a durable PFS after initial PRRT tended to have long-lasting PFS after salvage treatment (p = 0.04). None of the patients developed severe nephrotoxicity (grade 3/4) or a myelodysplastic syndrome during follow-up. Relevant albeit reversible haematotoxicity (grade 3/4) occurred in 7 patients (21.2 %). The cumulative administered activity was not associated with an increased incidence of haematotoxicity.

Conclusion

PRRT with 177Lu-octreotate in the re-treatment setting is safe and effective in patients with metastatic GEP-NET.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Amir Sabet, Torjan Haslerud, Amin Sabet, Hojjat Ahmadzadehfar, Stefan Guhlke, Hans-Jürgen Biersack & Samer Ezziddin

  2. Department of Hepatology and Gastroenterology, Charité, Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany

    Ulrich-Frank Pape

  3. Department of Nuclear Medicine, University Hospital, Frankfurt, Germany

    Frank Grünwald

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  1. Amir Sabet
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  2. Torjan Haslerud
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  9. Samer Ezziddin
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Correspondence to Samer Ezziddin.

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Sabet, A., Haslerud, T., Pape, UF. et al. Outcome and toxicity of salvage therapy with 177Lu-octreotate in patients with metastatic gastroenteropancreatic neuroendocrine tumours. Eur J Nucl Med Mol Imaging 41, 205–210 (2014). https://doi.org/10.1007/s00259-013-2547-z

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  • DOI: https://doi.org/10.1007/s00259-013-2547-z

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