Intra-arterial PRRT with Lu-177 DOTATATE in Liver-dominant Metastatic Neuroendocrine Tumors: Early Assessment of Efficacy and Toxicity
Author:
Puranik Ameya D1, Rangarajan Venkatesh1, Shetty Nitin Sudhakar2, Gala Kunal2, Kulkarni Suyash2, Mohite Ashish1, Marotkar Mandar1, Gawale Yogesh1, Dev Indraja D1, Shrikhande Shailesh V3, Chaudhari Vikram3, Bhandare Manish3, Agrawal Archi1, Shah Sneha1, Purandare Nilendu C1, Ghosh Suchismita1, Choudhury Sayak1
Affiliation:
1. Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India 2. Department of Radiodiagnosis, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India 3. Department of Surgical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
Abstract
Abstract
Purpose:
We proposed to administer Lu-177-DOTATATE in intra-arterial (IA) mode for higher first-pass localization to somatostatin receptors, higher residence time in liver metastases, and more radiation to tumor. This study aimed at assessing early hematological, renal and hepatotoxicity; and objective response to IA peptide receptor radionuclide therapy (PRRT).
Materials and Methods:
Fourteen patients (4 females and 10 males) were prospectively assessed. 5/14 patients underwent 2 cycles, whereas 3/14 underwent 3 cycles, and 6/14 received 1 cycle of IA PRRT. 200 mCi of Lu-177-DOTATATE was administered in 15–20 min by IA route under angiographic guidance. Patients were asked to follow-up at 4 and 8 weeks with hematological, liver, and renal functional parameters, and Ga-68 DOTATATE positron emission tomography/computed tomography (PET/CT) after 8 weeks. Response was assessed using RECIST 1.1 and EORTC PET criteria.
Results:
Safety: 2/14 patients had high total and direct bilirubin, which reverted to normal after IA PRRT. Three patients had low albumin, which improved after 1 cycle. Nine patients showed no worsening of liver function. Two patients showed Grade 1 hematotoxicity which reverted to normal. Five patients showed high creatinine, but preserved glomerular filtration rate and EC clearance. On follow-up at 8 weeks, serum creatinine reverted to normal. Efficacy: In five patients who underwent 2 cycles of IA PRRT, 3 showed partial response (PR) on RECIST 1.1 and partial metabolic response (PMR) on EORTC criteria, whereas 2 showed stable disease (SD). In patients who underwent 3 cycles, 1 showed SD, whereas other patient showed PMR on DOTANOC PET/CT, with PR in size. Among the remaining seven patients, 5 showed PMR, whereas the other 2 showed SD. Thus 9/14 patients showed PR, whereas 5 showed SD on metabolic and size criteria.
Conclusions:
IA PRRT is a safe and efficacious approach for the treatment of liver dominant metastatic neuroendocrine tumors.
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