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Safety of multiple repeated cycles of 177Lu-octreotate in patients with recurrent neuroendocrine tumour

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

Abstract

Purpose

Peptide receptor radionuclide therapy (PRRT) is an effective therapy in patients with a somatostatin receptor-positive neuroendocrine tumour (NET). Still unclear is how many cycles of 177Lu-octreotate can be repeated while maintaining an acceptable toxicity profile. The purpose of this study was to assess the safety of repeated PRRT in patients with recurrent NET.

Methods

We retrospectively evaluated data from 15 patients treated with repeated PRRT between 2004 and 2015. The median administered activity was 63.8 GBq (range 52–96.6 GBq) in a median of 9 cycles (range 8–13 cycles). Nonhaematological and haematological toxicities were assessed from clinical reports and laboratory data. The rates of adverse events in three therapy groups were compared: during cycles 1 to 4, cycles 5 to 8, and cycles 9 to 13. Baseline laboratory assessments were also compared with data obtained at the end of treatment. The overall survival in the study patients was compared with survival data in patients who received only a baseline PRRT of three or four cycles.

Results

We observed no life-threatening adverse events (CTC-4) during 177Lu-octreotate treatment. Reversible haematological toxicity (CTC-3) occurred in two patients (13%). No CTC-3/4 nephrotoxicity was recorded. More CTC-3 adverse events were recorded in the first therapy group than in the other two groups. Furthermore, there were no significant changes in the mean values of thrombocytes, leucocytes and serum creatinine before and after therapy. However, the mean haemoglobin levels fell from 14 g/dL to 11 g/dL. Finally, compared with those patients who received three or four cycles, there was a survival benefit in patients treated with repeated PRRT (censored overall survival 85.6 vs. 69.7 months, p < 0.001).

Conclusion

Therapy with eight or more cycles of 177Lu-octreotate was well tolerated and led to a survival benefit in patients with recurrent NET.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Anna Yordanova, Markus Essler & Hojjat Ahmadzadehfar

  2. Department of Internal Medicine 3, University Hospital Bonn, Bonn, Germany

    Karin Mayer & Peter Brossart

  3. Department of Internal Medicine 1, University Hospital Bonn, Bonn, Germany

    Maria A. Gonzalez-Carmona & Christian P. Strassburg

Authors
  1. Anna Yordanova
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  2. Karin Mayer
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  3. Peter Brossart
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  4. Maria A. Gonzalez-Carmona
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  5. Christian P. Strassburg
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  6. Markus Essler
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  7. Hojjat Ahmadzadehfar
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Correspondence to Hojjat Ahmadzadehfar.

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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.

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

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Yordanova, A., Mayer, K., Brossart, P. et al. Safety of multiple repeated cycles of 177Lu-octreotate in patients with recurrent neuroendocrine tumour. Eur J Nucl Med Mol Imaging 44, 1207–1214 (2017). https://doi.org/10.1007/s00259-017-3652-1

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  • DOI: https://doi.org/10.1007/s00259-017-3652-1

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