Medical Oncology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
Nuclear Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Front Endocrinol (Lausanne). 2021 Apr 15;12:676973. doi: 10.3389/fendo.2021.676973. eCollection 2021.
Peptide receptor radionuclide therapy (PRRT) is an established treatment in advanced neuroendocrine tumors (NETs), which overexpressed somatostatin receptors. However, after progression there are a limited number of available treatments. We want to share a case report about a patient with a NET re-treated with Lu-DOTATATE and a literature review about salvage treatment with PRRT. We present a 26-year-old man who started with pelvic pain and after a biopsy of a retro-rectal mass observed in a magnetic resonance was diagnosed with an advanced neuroendocrine tumour. After progression to lanreotide, everolimus and sunitinib, treatment with Lu-DOTATATE was initiated, achieving an excellent response with a progression free survival (PFS) of 38 months. At the time of progression, re-treatment with Lu-DOTATATE was decided, showing a new partial response, which is currently stable after 15 months. The patient had not presented significant treatment-related toxicity. Although there are no randomized phase III trials or a consensus about the number or dose of cycles, there is evidence about the efficacy and low toxicity of salvage treatment with Lu-DOTATATE in NETs. Median progression-free survival ranges from 6 to 22 months. Toxicity is mostly hematologic (anemia and neutropenia), 4-7% grade 3/4.
肽受体放射性核素治疗 (PRRT) 是一种已被证实的治疗方法，适用于过度表达生长抑素受体的晚期神经内分泌肿瘤 (NET)。然而，在疾病进展后，可用的治疗方法有限。我们想分享一个使用 Lu-DOTATATE 重新治疗 NET 的病例报告，并对 PRRT 的挽救治疗进行文献回顾。我们报告了一名 26 岁男性，最初表现为骨盆疼痛，在磁共振成像中观察到直肠后肿块，经活检后被诊断为晚期神经内分泌肿瘤。在进展为兰瑞肽、依维莫司和舒尼替尼后，开始使用 Lu-DOTATATE 治疗，取得了极好的反应，无进展生存期 (PFS) 为 38 个月。在进展时，决定重新使用 Lu-DOTATATE 治疗，显示出新的部分缓解，目前在 15 个月后仍然稳定。患者未出现明显的治疗相关毒性。虽然没有随机 III 期试验或关于周期数量或剂量的共识，但有证据表明 Lu-DOTATATE 对 NET 的挽救治疗具有疗效和低毒性。中位无进展生存期为 6 至 22 个月。毒性主要为血液学毒性（贫血和中性粒细胞减少），4-7%为 3/4 级。
