Carcinoid Therapy Radiotracers
(Collaboration of Dr. J Carmona and Dr. J Gonzalez)
Listed below it can be seen the most important radiopharmaceuticals employed currently to treat carcinoid tumors. Details of the protocol in each of them is described.
In addition it is important to mention that the combined use of these pharmaceuticals is under research and also the concomitant application with chemotherapy (1-4). Seregni E et al, propose the use of 5.55 GBq of 177Lu-Dotatate and 2.6 GBq of 90Y-Dotatate, alternated until complete 4 doses altogether.
Phillip G. et al on the other hand have found that combining with Zeloda (capecitabine) might be more effective that each other separated.
Strosberg J. et al. in 229 patients with 177Lu-Dotatate at a dose of 7.4 GBq every 8 weeks (four intravenous infusions, plus best supportive care including octreotide long-acting repeatable [LAR] administered intramuscularly at a dose of 30 mg) (177Lu- Dotatate group) or octreotide LAR alone administered intramuscularly at a dose of 60 mg every 4 weeks (control group) found:
1) At the estimated rate of progression-free survival at month 20 was 65.2% (95% confidence interval [CI], 50.0 to 76.8) in the 177Lu- Dotatate group and 10.8% (95% CI, 3.5 to 23.0) in the control group.
2) The response rate was 18% in the 177Lu-Dotatate group versus 3% in the control group (P<0.001).
3) 14 deaths in the 177Lu-Dotatate group and 26 in the control group (P=0.004).
4) Grade 3 or 4 neutropenia, thrombocyto- penia, and lymphopenia occurred in 1%, 2%, and 9%, respectively, of patients in the 177Lu-Dotatate group as compared with no patients in the control group, with no evidence of renal toxic effects during the observed time frame.
References:
1 Seregni E, Maccauro M, Coliva A, Castellani MR, Bajetta E, Aliberti G, Vellani C, Chiesa C, Martinetti A, Bogni A, Bombardieri E. Treatment with tandem [(90)Y]DOTA-TATE and [(177)Lu] DOTA-TATE of neuroendocrine tumors refractory to conventional therapy: preliminary results. Q J Nucl Med Mol Imaging. 2010 Feb; 54(1): 84-91.
2 Phillip G. Claringbold and Paul A. Brayshaw and Richard A. Price and J. Harvey Turner. Phase II study of radiopeptide 177Lu-octreotate and capecitabine therapy of progressive disseminated neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2011; 38: 302–311.
3 Frilling A, Weber F, Saner F, Bockisch A, Hofmann M, Mueller-Brand J, Broelsch CE. Treatment with (90)Y- and (177)Lu-DOTATOC in patients with metastatic neuroendocrine tumors. Surgery. 2006 Dec;140(6):968-76; discussion 976-7.
4 Strosberg J. et al. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med 2017;376:125-35. DOI: 10.1056/NEJMoa1607427