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Long-term results and tolerability of tandem peptide receptor radionuclide therapy with 90Y/177Lu-DOTATATE in neuroendocrine tumors with respect to the primary location: a 10-year study

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Abstract

Introduction

The peptide receptor radionuclide therapy (PRRT) with 90Y and 177Lu is a form of molecular targeted therapy for inoperable or disseminated neuroendocrine tumors (NET).

Aim

The aim of the study was to evaluate clinical results and long-term side effects of tandem 90Y /177Lu-DOTATATE therapy in patients with NET. Additionally, we evaluated clinical results with reference to the primary site.

Materials and methods

59 patients with disseminated NET were included in the study prospectively. 3–5 cycles of combined 1:1 90Y/177Lu-DOTATATE (total injected activity 11.1–16.65 GBq) with mixed amino acids for kidney protection were performed.

Results

During a median follow-up of 75.8 months, the PFS was 32.2 months, and the OS was 82 months; 25 patients died. Depending on primary tumor’s site, the PFS and the OS for pancreatic NET vs. small bowel, NET vs. large bowel, NET were 30.4 vs. 29.5 vs. 40.3 and 78.9 vs. 58.1 vs. 82.5, respectively. The observed 5-year overall survival was 63%, and a 2-year risk of progression was 39.4%. The following imaging response was observed: CR in 2%, PR in 22%, SD in 65%, and PD in 6% patients. The disease control rate was 89%. The objective response rate was 24%. The PRRT was well tolerated by all patients. One patient (2%) revealed MDS, and one patient (2%) grade 3 nephrotoxicity. No other grade 3 and 4 hematological or renal toxicity was observed.

Conclusions

These results indicated the tandem 90Y/177Lu-DOTATATE therapy for patients with disseminated/inoperable NET as highly effective and safe, considering long-term side effects. In the majority of patients, clinical improvement was observed.

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Authors and Affiliations

  1. Nuclear Medicine Department, Medical University of Warsaw, ul. Banacha 1 a, 02-097, Warsaw, Poland

    Jolanta Kunikowska & Leszek Królicki

  2. Radioisotope Centre POLATOM, National Centre for Nuclear Research, ul. Andrzeja Sołtana 7, 05-400, Otwock-Świerk, Poland

    Dariusz Pawlak & Renata Mikołajczak

  3. Department of Internal Medicine and Diabetology, Medical University of Warsaw, ul. Banacha 1 a, 02-097, Warsaw, Poland

    Marianna I. Bąk

  4. Division of Endocrinology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, ul. Ceglana 35, 40-514, Katowice, Poland

    Beata Kos-Kudła

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  1. Jolanta Kunikowska
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  2. Dariusz Pawlak
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Correspondence to Jolanta Kunikowska.

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Kunikowska, J., Pawlak, D., Bąk, M.I. et al. Long-term results and tolerability of tandem peptide receptor radionuclide therapy with 90Y/177Lu-DOTATATE in neuroendocrine tumors with respect to the primary location: a 10-year study. Ann Nucl Med 31, 347–356 (2017). https://doi.org/10.1007/s12149-017-1163-6

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  • DOI: https://doi.org/10.1007/s12149-017-1163-6

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