Radiosensitizing favors response to peptide receptor radionuclide therapy in patients with highly proliferative neuroendocrine malignancies: Preliminary evidence from a clinical pilot study Journal Article
| Authors: | Trautwein, N. F.; Hinterleitner, C.; Kiefer, L. S.; Singer, S.; Mattern, S.; Schwenck, J.; Reischl, G.; Sipos, B.; Lauer, U. M.; Dittmann, H.; Zender, L.; La Fougère, C.; Hinterleitner, M. |
| Article Title: | Radiosensitizing favors response to peptide receptor radionuclide therapy in patients with highly proliferative neuroendocrine malignancies: Preliminary evidence from a clinical pilot study |
| Abstract: | Aim/Introduction Peptide receptor radionuclide therapy (PRRT) represents a cornerstone of treatment regimens for patients with low proliferative neuroendocrine tumors (NETs). However, in patients experiencing somatostatin receptor-positive NET with higher proliferation rates, a value and potential therapeutic benefit of PRRT as part of multimodal treatment approaches and potentially with addition of radiosensitizing agents has not yet been established. Patients and Methods In this study, 20 patients with histologically confirmed gastroenteropancreatic (GEP) NET with proliferation rates (Ki67) between 15% and 55% were treated either with PRRT only (n = 10) or with a combination therapy (n = 10) comprising PRRT and capecitabine/temozolomide (CAP/TEM) for at least 2 consecutive cycles. Results Disease control rate in patients treated with PRRT alone was 60% (40% stable disease and 20% partial response). Strikingly, in patients treated with PRRT in combination with radiosensitization (CAP/TEM), the disease control rate was 90% (20% stable disease and 70% partial response). The median progression-free survival in the PRRT only group was 12 months, whereas the median progression-free survival in the PRRT + CAP/TEM group was 26 months and has not been yet reached for all patients in the group during the observation period. The median disease-specific survival for patients with PRRT alone was 51 months, whereas this end point was not yet reached in the PRRT + CAP/TEM group. Moreover, the PRRT + CAP/TEM group showed a significantly higher reduction of SSTR-PET-based metabolic tumor volume and chromogranin A levels compared with the PRRT only group. Importantly, adverse events of all grades did not differ between both groups. Conclusions PRRT + CAP/TEM represents a highly promising and well-tolerated therapeutic regimen for patients experiencing somatostatin receptor-positive NET with higher (Ki67 ≥ 15%) proliferation rate. Prospective randomized clinical trials are warranted. © Wolters Kluwer Health, Inc. All rights reserved. |
| Keywords: | adult; cancer chemotherapy; cancer survival; clinical article; controlled study; human tissue; treatment response; middle aged; unclassified drug; multimodality cancer therapy; capecitabine; cancer patient; pancreatic neoplasms; temozolomide; prospective study; prospective studies; ki 67 antigen; ki-67 antigen; metabolism; progression free survival; anemia; leukopenia; thrombocytopenia; pathology; retrospective study; neuroendocrine tumor; pilot study; pilot projects; pancreas tumor; octreotide; radioisotope; disease control; intestine tumor; intestinal neoplasms; radioisotopes; radiosensitizing agent; stomach neoplasms; disease specific survival; organometallic compound; organometallic compounds; radiosensitization; stomach tumor; neuroendocrine tumors; somatostatin receptor; chromogranin a; grading; gastroenteropancreatic neuroendocrine tumor; metabolic tumor volume; dotatate; humans; human; male; female; article; receptors, somatostatin; prrt; peptide receptor radionuclide therapy; radiosensitizing; gastro-enteropancreatic neuroendocrine tumor; <sup>177</sup>lu; highly proliferative net; lutetium ha dotatate lu 177 |
| Journal Title: | Clinical Nuclear Medicine |
| Volume: | 49 |
| Issue: | 3 |
| ISSN: | 0363-9762 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-03-01 |
| Start Page: | 207 |
| End Page: | 214 |
| Language: | English |
| DOI: | 10.1097/rlu.0000000000005006 |
| PUBMED: | 38271237 |
| PROVIDER: | scopus |
| PMCID: | PMC11444366 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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