Yadav Madhav Prasad, Ballal Sanjana, Bal Chandrasekhar
Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
EJNMMI Res. 2019 Feb 6;9(1):13. doi: 10.1186/s13550-019-0484-y.
The role of concomitant peptide receptor radionuclide therapy (PRRT) and capecitabine therapy has shown benefit in gastroenteropancreatic neuroendocrine tumors. However, data reporting its role in paraganglioma (PGL) patients is lacking. The aim of this study was to evaluate the role of combined capecitabine and Lu-DOTATATE in malignant PGL patients.
In this retrospective, single-institutional, single-arm, observational study, data of consecutive advanced stage PGL patients treated with concomitant Lu-DOTATATE-capecitabine therapy, between July 2009 and March 2017, were collected and analyzed.
Twenty-five PGL patients received an average dose of 22.86 ± 9.54 (14.43-50) GBq Lu-DOTATATE and 1250 mg/m capecitabine from days 0 to 14, commencing on the morning of PRRT. The median overall survival (OS) was not attained in this patient cohort; however, the median PFS was 32 months. Morphological response according to RECIST 1.1 criteria was achieved in 28% (7/25) patients. Biochemical response with > 50% reduction in chromogranin A levels was observed in 28% of the patients.
Our data confirm that Lu-DOTATATE-capecitabine therapy is effective in achieving an objective response in 28% and symptomatic response in 43% patients. In comparison to published PRRT monotherapy outcomes in PGL, we did not observe any great advantage of concomitant therapy; however, it could be due to under-powered study. We recommend a large randomized trial to prove or disprove the utility of capecitabine as a radiosensitizer for PRRT in PGL patients.
联合肽受体放射性核素治疗（PRRT）与卡培他滨治疗已显示出对胃肠胰神经内分泌肿瘤有益。然而，缺乏关于其在副神经节瘤（PGL）患者中作用的数据报告。本研究的目的是评估卡培他滨与镥[¹⁷⁷Lu] DOTATATE联合治疗在恶性PGL患者中的作用。
在这项回顾性、单机构、单臂观察性研究中，收集并分析了2009年7月至2017年3月期间接受镥[¹⁷⁷Lu] DOTATATE - 卡培他滨联合治疗的连续晚期PGL患者的数据。
25例PGL患者从PRRT治疗当天上午开始，在第0至14天接受了平均剂量为22.86±9.54（14.43 - 50）GBq的镥[¹⁷⁷Lu] DOTATATE和1250mg/m²的卡培他滨。该患者队列未达到中位总生存期（OS）；然而，中位无进展生存期（PFS）为32个月。根据RECIST 1.1标准，28%（7/25）的患者实现了形态学缓解。28%的患者观察到嗜铬粒蛋白A水平降低>50%的生化缓解。
我们的数据证实，镥[¹⁷⁷Lu] DOTATATE - 卡培他滨治疗在28%的患者中实现客观缓解，在43%的患者中实现症状缓解。与已发表的PGL中PRRT单药治疗结果相比，我们未观察到联合治疗有任何显著优势；然而，这可能是由于研究样本量不足。我们建议进行一项大型随机试验，以证明或反驳卡培他滨作为PGL患者PRRT放射增敏剂的效用。
