From the Departments of Nuclear Medicine.
Radiotherapy.
Clin Nucl Med. 2020 Sep;45(9):e393-e399. doi: 10.1097/RLU.0000000000003170.
Advanced inoperable/metastatic neuroendocrine tumors (NETs) pose a therapeutic challenge with limited treatment options. Peptide receptor radionuclide therapy (PRRT), being specific in targeting the somatostatin receptors, is a promising and viable option in this setting. In this study, we intended to evaluate the role of PRRT as the first-line systemic therapy in advanced inoperable/metastatic NETs.
Data of consecutive patients of advanced inoperable/metastatic NETs treated with first-line Lu-DOTATATE at our center, from September 2012 to August 2019, were collected and analyzed.
Forty-five patients (median age, 50 years; range, 14-72 years) with treatment-naive advanced NETs received a median cumulative dose of 27 GBq (range, 13.3-41.3 GBq; over 2-7 cycles) Lu-DOTATATE and 1250 mg/m capecitabine from days 0 to 14 of each PRRT cycle. Three patients were lost to follow-up, 2 had nonmeasurable lesions on CT, and hence, radiological response using Response Evaluation Criteria in Solid Tumors version 1.1 could be assessed in 40 patients. Twelve of 40 patients (30%) showed a partial response, whereas stable disease was observed in 22 of 40 patients (55%). Disease progression was limited to 6 of 40 patients (15%). Treatment-related adverse effects were minimal with grade 3/4 anemia, leukopenia, neutropenia, and hepatotoxicity observed in 2%, 2%, 4%, and 4% of the patients, respectively. Median progression-free survival was 48 months (95% confidence interval, 34.7-61.3 months).
Our results indicate the efficacy and safety of first-line PRRT in advanced NETs. Future randomized trials, comparing PRRT and somatostatin analogs in treatment-naive patients, are required to identify the definite sequence of treatment options for these patients.
晚期无法手术/转移性神经内分泌肿瘤（NET）的治疗极具挑战性，选择有限。肽受体放射性核素治疗（PRRT）因其特异性靶向生长抑素受体，在这种情况下是一种有前途且可行的选择。本研究旨在评估 PRRT 作为晚期无法手术/转移性 NET 一线全身治疗的作用。
收集并分析了 2012 年 9 月至 2019 年 8 月在我院接受一线 Lu-DOTATATE 治疗的晚期不可手术/转移性 NET 患者的连续数据。
45 例治疗初治的晚期 NET 患者（中位年龄为 50 岁；范围，14-72 岁）接受了中位数为 27GBq（范围，13.3-41.3GBq；2-7 个周期）的 Lu-DOTATATE 和中位数为 1250mg/m2 的卡培他滨，在每个 PRRT 周期的第 0-14 天。3 例患者失访，2 例患者 CT 显示不可测量病灶，因此可评估 40 例患者的实体瘤反应评价标准 1.1 版的放射学反应。40 例患者中，12 例（30%）有部分缓解，22 例（55%）为疾病稳定。疾病进展仅限于 6 例（15%）。治疗相关不良反应最小，仅 2%、2%、4%和 4%的患者分别出现 3/4 级贫血、白细胞减少、中性粒细胞减少和肝毒性。中位无进展生存期为 48 个月（95%置信区间，34.7-61.3 个月）。
我们的结果表明，一线 PRRT 治疗晚期 NET 的疗效和安全性。需要进行未来的随机试验，比较 PRRT 和生长抑素类似物在初治患者中的应用，以确定这些患者的治疗选择的确定顺序。
