[Y]Y/[Lu]Lu-奥曲肽重复肽受体放射性核素治疗（PRRT）在神经内分泌肿瘤（NET）患者中的安全性和有效性
The Safety and Efficacy of the Repeated PRRT with [Y]Y/[Lu]Lu-DOTATATE in Patients with NET.
作者信息
Zemczak Anna, Gut Paweł, Pawlak Dariusz, Kołodziej Maciej, Królicki Leszek, Kos-Kudła Beata, Ruchała Marek, Kamiński Grzegorz, Kunikowska Jolanta
机构信息
Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.
Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland.
出版信息
Int J Endocrinol. 2021 Jan 23;2021:6615511. doi: 10.1155/2021/6615511. eCollection 2021.
PURPOSE
The peptide receptor radionuclide therapy (PRRT) is a treatment option for patients with disseminated, inoperable G1 and G2 neuroendocrine tumours (NETs). The study aims to evaluate the safety, efficacy, and progression-free survival (PFS) of patients after retreatment (R-PRRT) and re-retreatment (RR-PRRT) with tandem isotopes [Y]Y/[Lu]Lu-DOTATATE. . Out of 99 treated patients with G1 and G2 NETs, 26 were included in the study and treated with the repeated PRRT (with 5 undergoing the re-repeated PRRT treatment) after an initial positive response to four PRRT cycles and later progression of the disease. [Ga]Ga-DOTATATE PET/CT and CT/MRI procedures were performed before and after the treatment. Patients were treated with [Y]Y/[Lu]Lu-DOTATATE (1 : 1) with mixed amino acid infusion for kidney protection. Toxicity was evaluated using the CTCAE 3.0 criteria.
RESULTS
The median follow-up was 88 months (the range: 42-164). The median cumulative administered activity was 22.2 GBq (the range: 17.8-30.7 GBq). Myelodysplastic syndrome occurred in one patient (3.8%), and grade 4 renal toxicity was also detected in one patient (3.8%). No other cases of grade 3 or 4 bone marrow and renal toxicity were observed. The median PFS rate was 31 months after the PRRT and 23 months following the R-PRRT. The OS rate from the diagnosis (OS-d) was 109 months and from the start of the PRRT (OS-t)-92.4 months. During the restaging, 3-6 months after the PRRT, PR, SD, and PD were observed in 19.2%, 80.8%, and 0% of the patients, respectively. After the R-PRRT, PR, SD, and PD were observed in 50%, 42.3%, and 7.7% of the patients, respectively.
CONCLUSIONS
The repeated therapy with [Y]Y/[Lu]Lu-DOTATATE is safe and effective for patients with disseminated, inoperable G1 and G2 neuroendocrine tumours.
目的
肽受体放射性核素治疗（PRRT）是播散性、无法手术切除的G1和G2级神经内分泌肿瘤（NETs）患者的一种治疗选择。本研究旨在评估患者接受串联同位素[Y]Y/[Lu]Lu - DOTATATE再治疗（R - PRRT）和再次再治疗（RR - PRRT）后的安全性、疗效及无进展生存期（PFS）。在99例接受治疗的G1和G2级NETs患者中，26例被纳入本研究，这些患者在最初对四个PRRT周期有阳性反应且随后疾病进展后，接受了重复PRRT治疗（其中5例接受了再次重复PRRT治疗）。在治疗前后进行了[Ga]Ga - DOTATATE PET/CT和CT/MRI检查。患者接受[Y]Y/[Lu]Lu - DOTATATE（1∶1）治疗，并输注混合氨基酸以保护肾脏。使用CTCAE 3.0标准评估毒性。
结果
中位随访时间为88个月（范围：42 - 164个月）。中位累积给药活度为22.2 GBq（范围：17.8 - 30.7 GBq）。1例患者（3.8%）发生骨髓增生异常综合征，1例患者（3.8%）检测到4级肾毒性。未观察到其他3级或4级骨髓和肾毒性病例。PRRT后中位PFS率为31个月，R - PRRT后为23个月。从诊断开始的总生存期（OS - d）为109个月，从PRRT开始的总生存期（OS - t）为92.4个月。在PRRT后3 - 6个月的再次分期中，分别有19.2%、80.8%和0%的患者观察到部分缓解（PR）、疾病稳定（SD）和疾病进展（PD）。R - PRRT后，分别有50%、42.3%和7.7%的患者观察到PR、SD和PD。
结论
对于播散性、无法手术切除的G1和G2级神经内分泌肿瘤患者，[Y]Y/[Lu]Lu - DOTATATE重复治疗安全有效。
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