Neuroendocrine tumor and lutetium therapy
DOI:
https://doi.org/10.29193/RMU.37.4.14Keywords:
NEUROENDOCRINE TUMORS, PANCREATIC NEOPLASMS, LUTETIUMAbstract
Introduction: gastroenteropancreatic neuroendocrine neoplasms (GEP-NET) are a group of several tumors originated in neuroendocrine cells, most of which are sporadic. These tumors are classified according to hormone secretion and cell differentiation. Treatment with radiomarked peptides or Peptide Receptor Radio- nuclide Therapy (PRRT) with lutetium 177-DOTATATE was approved by the FDA in 2018, since it has evidenced good results in advanced tumors compared to other therapies. The study presents the case of a patient with a pancreatic neuroendocrine tumor with secondary hepatic disease who was treated with this drug.
Clinical case: 65-year-old female patient carrier of a pancreatic neuroendocrine tumor with secondary hepatic disease who was diagnosed with a biopsy and presented somatostatin receptor (SSTR) expression. Given the extension of the lesion, medical treatment is indicated with somatostatin analogues that are poorly tolerated. Consequently, chemotherapy is indicated, with low performance tumor progression. Given the poor outcome, PRRT treatment as lutetium 177-DOTATATE is initiated. Cycles with lutetium 177-DOTATATE were observed to cause a minimum reduction in size and tumor uptake in the liver. Liver metastases evidenced no change and the patient remained clinically stable.
Conclusion: lutetium 177-DOTATATE therapy in a patient with a metastatic nonfunctioning neuroendocrine tumor, that could not be surgically resected produced an acceptable response for palliative treatment, since the tumor failed to progress. The patient continues to be clinically stable, asymptomatic, after 8 years of follow-up. Lutetium 177-DOTATATE therapy constitutes an effective option with limited side effects in unresectable GEP-NET tumors, or in the presence of metastases.
References
2) Anlauf M, Garbrecht N, Bauersfeld J, Schmitt A, Henopp T, Komminoth P, et al. Hereditary neuroendocrine tumors of the gastroenteropancreatic system. Virchows Arch 2007; 451(Suppl 1):S29-38. doi: 10.1007/s00428-007-0450-3
3) Garcia-Carbonero R, Capdevila J, Crespo-Herrero G, Díaz-Pérez J, Martínez Del Prado M, Alonso Orduña V, et al. Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE). Ann Oncol 2010; 21(9):1794-803. doi: 10.1093/annonc/mdq022
4) Nagtegaal I, Odze R, Klimstra D, Paradis V, Rugge M, Schirmacher P, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76(2):182-8. doi: 10.1111/his.13975
5) Capello A, Krenning E, Breeman W, Bernard B, de Jong M. Peptide receptor radionuclide therapy in vitro using [111In-DTPA0] octreotide. J Nucl Med 2003; 44(1):98-104.
6) Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, et al. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med 2017; 376(2):125-35. doi: 10.1056/NEJMoa1607427
7) Strosberg J, Wolin E, Chasen B, Kulke M, Bushnell D, Caplin M, et al. Improved time to quality of life deterioration in patients with progressive midgut neuroendocrine tumors treated with 177Lu-DOTATATE: the NETTER-1 trial. Ann Oncol 2017; 28(Suppl 5):v142-57. doi: 10.1093/annonc/mdx368.010
8) Hörsch D, Ezziddin S, Haug A, Gratz K, Dunkelmann S, Miederer M, et al. Effectiveness and side-effects of peptide receptor radionuclide therapy for neuroendocrine neoplasms in Germany: A multi-institutional registry study with prospective follow-up. Eur J Cancer 2016; 58:41-51. doi: 10.1016/j.ejca.2016.01.009
9) Zhang J, Song Q, Cai L, Xie Y, Chen Y. The efficacy of 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) in patients with metastatic neuroendocrine tumours: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2020; 146(6):1533-43. doi: 10.1007/s00432-020- 03181-2
