Phelps Tim E, Del Rivero Jaydira, Chertow Daniel S, Rosing Douglas, Pacak Karel, Lin Frank I
Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
JCEM Case Rep. 2024 Apr 10;2(4):luae049. doi: 10.1210/jcemcr/luae049. eCollection 2024 Apr.
Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-producing tumors that express somatostatin receptors (SSTR) that can be treated with lutetium-177 DOTATATE (Lu-177-TRT); however, treatment can be associated with life-threatening cardiovascular events. A patient case with management strategies for high-risk PPGL patients receiving Lu-177-TRT is described. The 78-year-old patient with metastatic paraganglioma was enrolled and treated under NCT03206060. Deemed to be at high risk, the patient was preemptively admitted to the intensive care unit (ICU) with central line access placed. Due to comorbidities, a reduced dose of 100 mCi x 4 cycles was used for this patient. Vital signs, blood work, and serum catecholamine levels were obtained at various time points. Despite reduced dosing, the patient still developed a severe hypertensive reaction with systolic blood pressure of 240 mmHg within minutes of Lu-177-TRT infusion, which was controlled with an intravenous nicardipine drip. The patient remained in the ICU for 24 hours post Lu-177-TRT before moving to an inpatient ward for an additional 24 hours. All subsequent infusions were performed using reduced doses with elective ICU admissions and were well-tolerated. Despite the increased risk, metastatic PPGL patients can be safely treated with proper staff training, monitoring, and preparation for intravenous medications, especially nicardipine.
嗜铬细胞瘤和副神经节瘤（PPGLs）是罕见的分泌儿茶酚胺的肿瘤，其表达生长抑素受体（SSTR），可用镥-177 DOTATATE（Lu-177-TRT）进行治疗；然而，治疗可能与危及生命的心血管事件相关。本文描述了一例接受Lu-177-TRT的高危PPGL患者的管理策略。这位78岁的转移性副神经节瘤患者参加了NCT03206060研究并接受治疗。由于被认为处于高危状态，该患者被预先收入重症监护病房（ICU），并放置了中心静脉通路。由于存在合并症，该患者使用了100 mCi×4个周期的减量方案。在不同时间点获取生命体征、血液检查结果和血清儿茶酚胺水平。尽管剂量减少，但患者在Lu-177-TRT输注后几分钟内仍出现严重高血压反应，收缩压达240 mmHg，通过静脉滴注尼卡地平得以控制。患者在Lu-177-TRT治疗后在ICU停留了24小时，之后转至住院病房又待了24小时。所有后续输注均采用减量方案，并选择性收入ICU，患者耐受性良好。尽管风险增加，但通过适当的人员培训、监测以及对静脉用药尤其是尼卡地平的准备，转移性PPGL患者可以得到安全治疗。
