Service d'Oncologie Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France;
Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave-Roussy, Villejuif, France.
J Nucl Med. 2024 Sep 3;65(9):1416-1422. doi: 10.2967/jnumed.123.267363.
Everolimus and peptide receptor radionuclide therapy (PRRT, Lu-DOTATATE) are 2 treatments recommended in guidelines for gastroenteropancreatic metastatic neuroendocrine tumors. However, the best treatment sequence remains unknown. We designed a retrospective multicenter study that included patients from the national prospective database of the Groupe d'Étude des Tumeurs Endocrines who had been treated using everolimus and PRRT between April 2004 and October 2022. The primary aim was to compare the 2 treatments (everolimus and PRRT) in terms of efficacy and safety, and the secondary aim was to evaluate the sequences (PRRT followed by everolimus or everolimus followed by PRRT) based on overall progression-free survival (PFS) (PFS during first treatment + PFS during second treatment) in patients with metastatic neuroendocrine tumors. Both treatments were used for 84 patients. The objective response rate and median PFS were 5 (6.0%) and 16.1 mo (95% CI, 11.5-20.7 mo), respectively, under everolimus and 19 (22.6%) and 24.5 mo (95% CI, 17.7-31.3 mo), respectively, for PRRT. The safety profile was also better for PRRT. Median overall PFS was 43.2 mo (95% CI, 33.7-52.7 mo) for the everolimus-PRRT sequence and 30.6 mo (95% CI, 17.8-43.4 mo) for the PRRT-everolimus sequence (hazard ratio, 0.69; 95% CI, 0.39-1.24; = 0.22). PRRT was more effective and less toxic than everolimus. Overall PFS was similar between the 2 sequences, suggesting case-by-case discussion if the patient is eligible for both treatments, but PRRT should be used first when an objective response is needed or in frail populations.
依维莫司和肽受体放射性核素治疗（PRRT，Lu-DOTATATE）是指南中推荐用于治疗胃肠胰腺转移性神经内分泌肿瘤的两种治疗方法。然而，最佳的治疗顺序仍不清楚。我们设计了一项回顾性多中心研究，纳入了 2004 年 4 月至 2022 年 10 月期间在国家内分泌肿瘤研究组前瞻性数据库中接受依维莫司和 PRRT 治疗的患者。主要目的是比较两种治疗方法（依维莫司和 PRRT）的疗效和安全性，次要目的是根据转移性神经内分泌肿瘤患者的总无进展生存期（PFS）（首次治疗期间的 PFS+第二次治疗期间的 PFS）评估治疗顺序（PRRT 后序贯依维莫司或依维莫司后序贯 PRRT）。两种治疗方法均用于 84 例患者。依维莫司治疗的客观缓解率和中位 PFS 分别为 5（6.0%）和 16.1 个月（95%CI，11.5-20.7 个月），PRRT 治疗的分别为 19（22.6%）和 24.5 个月（95%CI，17.7-31.3 个月）。PRRT 的安全性也更好。依维莫司-PRRT 序贯和 PRRT-依维莫司序贯的中位总 PFS 分别为 43.2 个月（95%CI，33.7-52.7 个月）和 30.6 个月（95%CI，17.8-43.4 个月）（风险比，0.69；95%CI，0.39-1.24；=0.22）。PRRT 比依维莫司更有效且毒性更小。两种治疗顺序的总 PFS 相似，如果患者适合两种治疗方法，则应根据具体情况进行讨论，但如果需要客观缓解或患者身体虚弱，则应首先使用 PRRT。
