Departments of Nuclear Medicine.
Otolaryngology (Head and Neck Surgery), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Nucl Med Commun. 2020 Jul;41(7):629-635. doi: 10.1097/MNM.0000000000001205.
Peptide receptor radionuclide therapy (PRRT) has been shown to be useful in inoperable/metastatic medullary thyroid carcinoma (MTC). However, the role of concomitant PRRT and low-dose capecitabine therapy has not yet been studied in these patients. This study was conducted to evaluate the efficacy and safety of this combination approach in advanced MTC.
This was a retrospective, single-centre study. Data of consecutive patients of advanced inoperable/metastatic MTC treated with concomitant Lu-DOTATATE+capecitabine, from January 2014 to August 2018, were collected and analysed for radiological, molecular and biochemical responses and treatment-related toxicity.
Eight patients with advanced MTC received a median cumulative dose of 20.9 GBq (interquartile range 8.9-27.7 GBq) Lu-DOTATATE over 1-4 cycles and 1250 mg/m capecitabine from days 0 to 14 of each PRRT cycle. Radiological response according to Response Evaluation Criteria in Solid Tumours 1.1 criteria could be assessed in seven patients. Six out of seven patients (86%) had stable disease, while disease progression was observed in 1/7 (14%) patients. However, molecular response, as per the European Organization for Research and Treatment of Cancer criteria, was observed in all the seven patients. Biochemical response with reduction in serum calcitonin levels was observed in 3/5 (60%) patients. With the exception of grade 2 anaemia in one patient, no other significant toxicity was observed in this cohort.
Our results indicate the efficacy and safety of concomitant Lu-DOTATATE and capecitabine in advanced MTC. Larger randomized controlled trials are, however, required to establish the role of capecitabine as a radiosensitizer along with PRRT in these patients.
肽受体放射性核素疗法（PRRT）已被证明对无法手术/转移性甲状腺髓样癌（MTC）有效。然而，在这些患者中，尚未研究同时进行 PRRT 和低剂量卡培他滨治疗的作用。本研究旨在评估这种联合治疗方法在晚期 MTC 中的疗效和安全性。
这是一项回顾性的单中心研究。收集并分析了 2014 年 1 月至 2018 年 8 月期间连续接受 Lu-DOTATATE+卡培他滨联合治疗的晚期不可手术/转移性 MTC 患者的数据，以评估其影像学、分子和生化反应以及与治疗相关的毒性。
8 例晚期 MTC 患者接受了中位数累积剂量为 20.9GBq（四分位距 8.9-27.7GBq）的 Lu-DOTATATE，共 1-4 个周期，并在每个 PRRT 周期的 0 至 14 天接受 1250mg/m 卡培他滨治疗。根据实体瘤反应评价标准 1.1 标准，可评估 7 例患者的影像学反应。7 例患者中有 6 例（86%）为疾病稳定，1 例（14%）为疾病进展。然而，根据欧洲癌症研究与治疗组织标准，所有 7 例患者均观察到了分子反应。7 例患者中有 3 例（60%）观察到血清降钙素水平下降的生化反应。除 1 例患者出现 2 级贫血外，该队列未观察到其他严重毒性。
我们的结果表明，Lu-DOTATATE 和卡培他滨联合治疗晚期 MTC 的疗效和安全性。然而，需要更大规模的随机对照试验来确定卡培他滨作为放射增敏剂与 PRRT 联合应用于这些患者的作用。
