Purpose: Peptide receptor radionuclide therapy (PRRT) is a valid therapy for grade 1/2 gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs). Although a median progression-free survival (PFS) of more than 20Â months is frequently observed, the majority of patients relapse after 2Â âÂ 3Â years. In the present study, we investigated the use of low dosage re-treatment with 177Lu-DOTATATE (Lu-PRRT) in patients with GEP-NENs who relapsed after treatment with 90Y-DOTATOC (Y-PRRT). Methods: Upon tumour progression, 26 patients with a PFS of at least 12Â months after Y-PRRT were consecutively enrolled in a phase II study of re-treatment with Lu-PRRT. All patients had preserved kidney and haematological parameters and received 14.8Â âÂ 18.5Â GBq of Lu-PRRT in four or fiveÂ cycles. The disease control rate (DCR), toxicity, PFS and prognostic factors were evaluated. Results: Median total activity of Lu-PRRT was 16.5Â GBq in fiveÂ cycles. The DCR was 84.6Â %, median PFS was 22Â months (95Â % CI 16Â monthsÂ âÂ not reached) compared to 28Â months (95Â % CI 20Â âÂ 36Â months) after Y-PRRT. Tumour burden and number of liver metastases were important prognostic factors. Toxicity was mild after Lu-PRRT re-treatment in the majority of patients, with only two patients with grade 2 and one with grade 3 bone marrow toxicity; one patient had grade 2 and one grade 3 renal toxicity. Conclusion: Patients with GEP-NEN who have previously responded to Y-PRRT are suitable candidates for Lu-PRRT re-treatment on progression. Although our sample size was limited, low-dosage Lu-PRRT was safe, and led to DCR and PFS rates comparable with those observed when Y-PRRT was used as primary treatment.
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|Titolo:||Feasibility and utility of re-treatment with 177Lu-DOTATATE in GEP-NENs relapsed after treatment with 90Y-DOTATOC|
|Data di pubblicazione:||2015|
|Appare nelle tipologie:||03.1 Articolo su rivista|