Neuroendocrine Unit, Royal Free London NHS Foundation Trust, London, United Kingdom;
Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom.
J Nucl Med. 2022 Oct;63(10):1503-1508. doi: 10.2967/jnumed.121.263056. Epub 2022 Feb 24.
Our purpose was to assess the efficacy and safety of Lu-DOTATATE in neuroendocrine tumor patients with reduced renal function. A single-center retrospective analysis was performed on 33 patients with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m Of these, 26 had chronic kidney disease (CKD) stage 3a (eGFR, 45-60 mL/min/1.73 m) and 7 had CKD 3b (eGFR, 30-45 mL/min/1.73 m). Renal toxicity and temporal changes in eGFR were recorded. The association between potential risk factors and any kidney function deterioration (>10% reduction in eGFR) was evaluated. Data on survival, the radiologic response assessment, and quality of life were collected. The incidence of permanent grade 3 or 4 nephrotoxicity was 3% (a single patient with grade 4 nephrotoxicity). The mean annual reduction in eGFR was estimated at 2.5%. A permanent decline of less than 10% in eGFR of any grade was recorded in 45% of patients ( = 15). Nine patients moved into higher CKD categories (8 patients who moved from CKD 3a to CKD 3b and 1 patient who moved from CKD 3b to CKD 5). No significant relationship was found between renal risk factors and a permanent reduction in renal function. Grade 3 or 4 bone marrow toxicity was observed in 9% of patients. The estimated median progression-free survival was 42 mo, and the median overall survival was 47 mo. At the end of treatment, the radiologic assessment showed a partial response in 33%, stable disease in 55%, and progressive disease in 12%. There was an improvement in global quality of life and endocrine score (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-Gastrointestinal NET-21) ( = 0.046 and 0.041, respectively). Lu-DOTATATE appears to be generally well tolerated in patients with preexisting CKD 3, with a low incidence of permanent major nephrotoxicity. Lu-DOTATATE appears to have a good therapeutic effect, with most patients reporting improvement in quality of life.
我们的目的是评估 Lu-DOTATATE 在肾功能降低的神经内分泌肿瘤患者中的疗效和安全性。对 33 名估计肾小球滤过率（eGFR）<60 mL/min/1.73 m2 的患者进行了单中心回顾性分析，其中 26 名患者患有慢性肾脏病（CKD）3a 期（eGFR，45-60 mL/min/1.73 m2），7 名患者患有 CKD 3b 期（eGFR，30-45 mL/min/1.73 m2）。记录了肾毒性和 eGFR 的时间变化。评估了潜在危险因素与任何肾功能恶化（eGFR 降低>10%）之间的关系。收集了生存、影像学反应评估和生活质量的数据。永久性 3 级或 4 级肾毒性的发生率为 3%（1 例患者出现 4 级肾毒性）。估计 eGFR 的年平均下降率为 2.5%。45%的患者（=15）记录到任何等级的 eGFR 永久性下降<10%。9 名患者进入更高的 CKD 类别（8 名患者从 CKD 3a 期转为 CKD 3b 期，1 名患者从 CKD 3b 期转为 CKD 5 期）。未发现肾危险因素与肾功能永久性下降之间存在显著关系。骨髓毒性 3 级或 4 级的发生率为 9%。估计无进展生存期的中位数为 42 个月，总生存期的中位数为 47 个月。治疗结束时，影像学评估显示部分缓解 33%，稳定疾病 55%，进展性疾病 12%。全球生活质量和内分泌评分（欧洲癌症研究与治疗组织生活质量问卷-胃肠道神经内分泌肿瘤 21 项）均有改善（=0.046 和 0.041）。Lu-DOTATATE 似乎在患有预先存在的 CKD 3 的患者中总体耐受性良好，永久性严重肾毒性的发生率较低。Lu-DOTATATE 似乎具有良好的治疗效果，大多数患者报告生活质量改善。
