Outcome analysis in patients with metastatic gastroenteropancreatic neuroendocrine tumors receiving peptide receptor radionuclide therapy with Lu-177-DOTATATE

Dominique Prétot; Ivette Engel-Bicik; David Kenkel; Philipp A Kaufmann; Valerie Treyer; Alexander R Siebenhüner

doi:10.21037/jgo-22-874

Outcome analysis in patients with metastatic gastroenteropancreatic neuroendocrine tumors receiving peptide receptor radionuclide therapy with Lu-177-DOTATATE

J Gastrointest Oncol. 2023 Jun 30;14(3):1204-1217. doi: 10.21037/jgo-22-874. Epub 2023 May 25.

Authors

Dominique Prétot¹, Ivette Engel-Bicik¹, David Kenkel¹, Philipp A Kaufmann¹, Valerie Treyer^#^{1

2}, Alexander R Siebenhüner^#^{3

4}

Affiliations

¹ Department of Nuclear Medicine, University Hospital Zurich (USZ), Zurich, Switzerland.
² Institute for Regenerative Medicine, University of Zurich, Switzerland.
³ Department of Hematology/Oncology, University Hospital Zurich (USZ), Zurich, Switzerland.
⁴ Department of Hematology/Oncology, Kantonsspital Schaffhausen, Schaffhausen, Switzerland.

^# Contributed equally.

Abstract

Background: Patients with neuroendocrine tumors (NET) of the gastroenteropancreatic tract (GEP-NET) were effectively treated with peptide receptor radionuclide therapy (PRRT) with Lu-177-DOTATATE in the NETTER-1 trial. The aim of this study was to assess the outcome of metastatic GEP-NET patients within a European Neuroendocrine Tumor Society (ENETS) certified center of excellence after this treatment.

Methods: A total of 41 GEP-NET patients who received PRRT with Lu-177-DOTATATE between 2012 and 2017 at a single center were included in this analysis. Data on pre- and post-PRRT treatments [selective internal radiation therapy (SIRT), somatostatin analogue therapy (SSA), blood parameters, patient symptomatic burden and overall survival] was extracted from patient records.

Results: Overall, PRRT was well tolerated and did not increase patient symptomatic burden. Blood parameters were not significantly affected by PRRT (means before and after therapy: hemoglobin: 125.4 vs. 122.3 mg/L, P=0.201; creatinine: 73.8 vs. 77.7 µmol/L, P=0.146), while leukocytes (6.6 vs. 5.6 G/L, P<0.01) and platelets (269.9 vs. 216.7 G/L, P<0.001) were significantly decreased yet without clinical significance in our study. Seven of 9 patients with SIRT treatment prior to PRRT were deceased (mortality odds ratio =4.083). The mortality odds ratio of patients with a pancreatic tumor and SIRT was 1.33 compared to patients with a different tumor origin. 6 of 15 patients (40%) with post-PRRT SSA were deceased (mortality odds ratio =0.429 without SSA after PRRT).

Conclusions: Patients with advanced GEP-NET might benefit from PRRT with Lu-177-DOTATATE as it can provide a valuable treatment modality in advanced disease stages. Safety profiles of PRRT were manageable without increasing the symptomatic burden. SIRT before PRRT or lack of SSA after PRRT seem to impair the response and reduce survival.

Keywords: Lu-177-DOTATATE; Peptide receptor radionuclide therapy (PRRT); health-related quality of life (HRQoL); mortality; neuroendocrine tumors (NET); selective internal radiation therapy (SIRT); somatostatin analogue therapy (SSA).