Purpose: Typical and atypical carcinoids (TC and AC) represent 20Â âÂ 25Â % of all neuroendocrine tumours. No standard therapeutic approach is available for patients with advanced disease. The aim of this phase II study was to investigate the efficacy and safety of peptide receptor radionuclide therapy with 177Lu-DOTATATE (Lu-PRRT) and the role of thyroid transcription factor 1 (TTF-1) and 18F-FDG PET as prognostic factors in patients with advanced TC or AC. Methods: A total of 34 consecutive patients with radiologically documented progressive disease were treated with Lu-PRRT at a therapeutic cumulative activity of 18.5 or 27.8Â GBq in four or fiveÂ cycles according to the patientâs kidney function and bone marrow reserve. Information on TTF-1 was available in all patients. FDG PET studies prior to Lu-PRRT were available in 29 patients. Results: The median follow-up was 29Â months (range 7Â âÂ 69Â months). The disease control rate (DCR) in patients with TC was 80Â %: 6Â % complete response, 27Â % partial response and 47Â % stable disease. The median progression-free survival (mPFS) was 20.1Â months (95Â % CI 11.8Â âÂ 26.8Â months). Stable disease was achieved in 47Â % of patients with AC with a mPFS of 15.7Â months (95Â % CI 10.6Â âÂ 25.9Â months). No major acute or delayed toxicity occurred in either group or with either cumulative activity. mPFS in patients with TTF-1-negative TC was 26.3Â months (95Â % CI 12.9Â âÂ 45.2Â months), but in patients with TTF-1-positive TC mPFS was 7.2Â months (4.2Â âÂ 14.0Â months; p = 0.0009). FDG PET was negative in 13 patients (10 TC and 3 AC) and positive in 16 patients (4 TC and 12 AC). The mPFS in the FDG PET-negative group was 26.4Â months (95Â % CI 14.2Â âÂ 48.9Â months) and 15.3Â months (11.7Â âÂ 31.1Â months) in the FDG PET-positive group. Conclusion: Lu-PRRT showed antitumour activity in terms of DCR and PFS and proved safe, even in patients with a higher risk of side effects. TTF-1 would appear to be a prognostic factor. FDG PET positivity in bronchial carcinoids is a hallmark of aggressive tumour and is more frequent in patients with AC than in those with TC.
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|Titolo:||Peptide receptor radionuclide therapy with 177Lu-DOTATATE in advanced bronchial carcinoids: prognostic role of thyroid transcription factor 1 and 18F-FDG PET|
|Data di pubblicazione:||2016|
|Appare nelle tipologie:||03.1 Articolo su rivista|