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Prospective Within-Patient Assessment of the Impact of an Unlabeled Octreotide Pre-dose on the Biodistribution and Tumor Uptake of 68Ga DOTATOC as Assessed by Dynamic Whole-body PET in Patients with Neuroendocrine Tumors: Implications for Diagnosis and Therapy

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Abstract

Purpose

Gastroenteropancreatic neuroendocrine tumors (GEP NETs) are often associated with high expression of somatostatin receptors (SSTRs) which allows for PET/CT imaging with radiolabeled somatostatin analogs such as 68Ga-DOTATOC. The interplay between 68Ga-DOTATOC and the synthetic somatostatin analogs commonly used to manage patient symptoms may lead to competition between the labelled and unlabeled peptides for receptor binding sites and current product labelling recommends patients be taken off somatostatin analogs before imaging. In this study, we prospectively investigated in human patients the effect of a pre-dose of octreotide, a short-acting somatostatin analog, on the distribution of 68Ga-DOTATOC in GEP NETs and normal organs.

Procedure

Research participants with GEP NETs were studied on two occasions using dynamic whole-body 68Ga-DOTATOC PET/CT. The two imaging studies were performed within 21 days of each other, using an identical acquisition protocol except for the administration of 50 μg of short-acting octreotide (pre-dose) immediately before the second PET/CT. Paired t-tests were used to compare tracer uptake with and without octreotide, for tumor and various normal organs.

Results

Seven participants with a mean age of 53 ± 10 years were studied. Octreotide pre-dosing decreased radiotracer uptake in the normal liver and spleen by 25 % (p = 0.04) and 47 % (p = 0.05) respectively but did not significantly change uptake in tumor (p = 0.53), red marrow (p = 0.12), kidneys (p =0.57), or pituitary gland (p = 0.27).

Conclusions

Our data indicate SSTR imaging can be improved with a pre-dose of unlabeled octreotide given just prior to injection of the radiotracer. These data suggest there may be no need to discontinue somatostatin analog therapy prior to PET/CT with 68Ga-DOTATOC, allowing for a simpler, less disruptive patient protocol. This approach warrants further study in a variety of settings.

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Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Martin A. Lodge, Lilja B. Solnes & Muhammad A. Chaudhry

  2. The Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Richard L. Wahl

Authors
  1. Martin A. Lodge
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  2. Lilja B. Solnes
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  3. Muhammad A. Chaudhry
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  4. Richard L. Wahl
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Contributions

Dr Wahl conceived the study and was responsible for the design, funding, and administrative aspects. Drs Solnes, Chaudhry, and Wahl were responsible for patient data acquisition and analysis. Dr Lodge was responsible for study design, data analysis, and was the primary author of the manuscript. All co-authors contributed to the writing of the paper, have approved the final version, and have agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Martin A. Lodge.

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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 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lodge, M.A., Solnes, L.B., Chaudhry, M.A. et al. Prospective Within-Patient Assessment of the Impact of an Unlabeled Octreotide Pre-dose on the Biodistribution and Tumor Uptake of 68Ga DOTATOC as Assessed by Dynamic Whole-body PET in Patients with Neuroendocrine Tumors: Implications for Diagnosis and Therapy. Mol Imaging Biol 23, 766–774 (2021). https://doi.org/10.1007/s11307-021-01600-5

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  • DOI: https://doi.org/10.1007/s11307-021-01600-5

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