Pencharz Deborah, Walker Martin, Yalchin Mehmet, Quigley Ann-Marie, Caplin Martyn, Toumpanakis Christos, Navalkissoor Shaunak
Departments of aNuclear Medicine bGastroenterology and Neuroendocrine Tumours, Royal Free Hospital cSchool of Public Health, Faculty of Medicine, Imperial College, London, UK.
Nucl Med Commun. 2017 Jul;38(7):593-600. doi: 10.1097/MNM.0000000000000685.
Lutetium-177 DOTA-D-Phe1-Tyr3-octreotide (Lu-DOTATATE) is a treatment option for patients with well-differentiated metastatic neuroendocrine tumours. Our centre started administering this therapy in 2012. The aim of this study was therefore to analyse the first cohort of patients treated with Lu-DOTATATE to determine its early efficacy and toxicity.
We retrospectively analysed patient, tumour and treatment characteristics, end-of-treatment outcome, time to progression and toxicity in 79 consecutive patients treated with Lu-DOTATATE who had progressive NET according to Response Evaluation Criteria in Solid Tumours criteria. Follow-up time was 12-40 months. Study of Kaplan-Meier plots, analysis of time to progression and multiple regression analysis of factors predictive of time to progression were performed.
At end-of-treatment radiological restaging, 13% of patients were found to have partial response and 64% to have stable disease; 23% of patients progressed through treatment. Overall, 47% of patients demonstrated a reduction in chromogranin A levels. The overall estimated median time to progression from the start of treatment was 28 months for the entire cohort and 31, 30 and 5 months for those with partial response, stable disease and progressive disease, respectively. On multivariate regression analysis, higher grade of tumour was found to be significantly associated with shorter progression-free survival. Three patients experienced grade 1 haematotoxicity, five grade 1 nephrotoxicity and one grade 2 nephrotoxicity.
Early outcomes of patients treated with Lu-DOTATATE are similar to those in previously published series in terms of end-of-treatment efficacy and toxicity. This provides further evidence that this is a safe and efficacious form of treatment for patients with progressive metastatic neuroendocrine tumours.
镥-177 奥曲肽（Lu-DOTATATE）是分化良好的转移性神经内分泌肿瘤患者的一种治疗选择。我们中心于 2012 年开始应用这种疗法。因此，本研究的目的是分析首批接受 Lu-DOTATATE 治疗的患者队列，以确定其早期疗效和毒性。
我们回顾性分析了 79 例连续接受 Lu-DOTATATE 治疗且根据实体瘤疗效评价标准患有进展期神经内分泌肿瘤（NET）患者的患者、肿瘤和治疗特征、治疗结束时的结局、进展时间和毒性。随访时间为 12 - 40 个月。进行了 Kaplan-Meier 曲线研究、进展时间分析以及对预测进展时间的因素进行多元回归分析。
在治疗结束时的影像学重新分期中，发现 13%的患者有部分缓解，64%病情稳定；23%的患者在治疗过程中病情进展。总体而言，47%的患者嗜铬粒蛋白 A 水平降低。整个队列从治疗开始的总体估计中位进展时间为 28 个月，部分缓解、病情稳定和病情进展的患者分别为 31、30 和 5 个月。多变量回归分析显示，肿瘤分级较高与无进展生存期较短显著相关。3 例患者出现 1 级血液毒性，5 例出现 1 级肾毒性，1 例出现 2 级肾毒性。
在治疗结束时的疗效和毒性方面，接受 Lu-DOTATATE 治疗患者的早期结果与先前发表的系列研究相似。这进一步证明了这是一种治疗进展期转移性神经内分泌肿瘤患者安全有效的治疗方式。
