Sue Ping Thang1,2, Mei Sim Lung3, Grace Kong1, Michael S Hofman1, Jason Callahan1, Michael Michael3, Rodney J Hicks4. 1. Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. 2. Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore. 3. Division of Cancer Medicine, Neuroendocrine Tumour Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. 4. Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. Rod.Hicks@petermac.org.
Abstract
PURPOSE: Grade 3 NENs are aggressive tumours with poor prognosis. PRRT+/- radiosensitising chemotherapy is a potential treatment for disease with high somatostatin receptor (SSTR) expression without spatially discordant FDG-avid disease. We retrospectively evaluated the efficacy of PRRT in G3 NEN. METHODS: Kaplan-Meier estimation was used to determine progression-free survival (PFS) and overall survival (OS) defined from start of PRRT. Subgroup analysis was performed for patients with Ki-67 ≤ 55% and >55%. Anatomical response (RECIST 1.1) and toxicity 3 months after PRRT was determined. Disease control rate (DCR) was defined as complete response (CR), partial response (PR) and stable disease (SD) of those with prior progression. RESULTS: 28 patients (M = 17; age 16-78 years; Ki-67 ≤ 55% = 22) were reviewed. 17 patients had pancreatic, 5 small bowel, 3 large bowel, 2 bronchial and 1 unknown primary disease. 25/28 had significant FDG-avid disease prior to treatment. Most had 177Lu-DOTA-octreotate (median cumulative activity 24.4 GBq, median 4 cycles). Twenty patients had radiosensitising chemotherapy. 89% were treated for disease progression; 79% after prior chemotherapy. Median follow-up was 29 months. The median PFS was 9 months for all patients. 16 patients died (Ki-67 ≤ 55% = 11; Ki-67 > 55% = 5) with median OS of 19 months. For Ki-67 ≤ 55% (N = 22), the median PFS was 12 months and median OS 46 months. For Ki-67 > 55% (N = 6), the median PFS was 4 months and median OS 7 months. On CT imaging, DCR at 3 months post-PRRT was 74%, 35% (8/23) PR and 39% (9/23) SD. Eleven patients received further PRRT due to recrudescent disease after response. Five patients developed progression of discordant FDG-avid disease and were referred for targeted therapy/chemotherapy. Grade 3 and 4 lymphopenia and thrombocytopenia occurred in five and five patients, respectively. No renal or liver toxicity related to treatment was seen. CONCLUSIONS: PRRT achieves clinically relevant disease control with acceptable toxicity in G3 NENs.
PURPOSE: Grade 3 NENs are aggressive tumours with poor prognosis. PRRT+/- radiosensitising chemotherapy is a potential treatment for disease with high somatostatin receptor (SSTR) expression without spatially discordant FDG-avid disease. We retrospectively evaluated the efficacy of PRRT in G3 NEN. METHODS: Kaplan-Meier estimation was used to determine progression-free survival (PFS) and overall survival (OS) defined from start of PRRT. Subgroup analysis was performed for patients with Ki-67 ≤ 55% and >55%. Anatomical response (RECIST 1.1) and toxicity 3 months after PRRT was determined. Disease control rate (DCR) was defined as complete response (CR), partial response (PR) and stable disease (SD) of those with prior progression. RESULTS: 28 patients (M = 17; age 16-78 years; Ki-67 ≤ 55% = 22) were reviewed. 17 patients had pancreatic, 5 small bowel, 3 large bowel, 2 bronchial and 1 unknown primary disease. 25/28 had significant FDG-avid disease prior to treatment. Most had 177Lu-DOTA-octreotate (median cumulative activity 24.4 GBq, median 4 cycles). Twenty patients had radiosensitising chemotherapy. 89% were treated for disease progression; 79% after prior chemotherapy. Median follow-up was 29 months. The median PFS was 9 months for all patients. 16 patients died (Ki-67 ≤ 55% = 11; Ki-67 > 55% = 5) with median OS of 19 months. For Ki-67 ≤ 55% (N = 22), the median PFS was 12 months and median OS 46 months. For Ki-67 > 55% (N = 6), the median PFS was 4 months and median OS 7 months. On CT imaging, DCR at 3 months post-PRRT was 74%, 35% (8/23) PR and 39% (9/23) SD. Eleven patients received further PRRT due to recrudescent disease after response. Five patients developed progression of discordant FDG-avid disease and were referred for targeted therapy/chemotherapy. Grade 3 and 4 lymphopenia and thrombocytopenia occurred in five and five patients, respectively. No renal or liver toxicity related to treatment was seen. CONCLUSIONS: PRRT achieves clinically relevant disease control with acceptable toxicity in G3 NENs.
Authors: M Heetfeld; C N Chougnet; I H Olsen; A Rinke; I Borbath; G Crespo; J Barriuso; M Pavel; D O'Toole; T Walter Journal: Endocr Relat Cancer Date: 2015-06-25 Impact factor: 5.678
Authors: Laura H Tang; Brian R Untch; Diane L Reidy; Eileen O'Reilly; Deepti Dhall; Lily Jih; Olca Basturk; Peter J Allen; David S Klimstra Journal: Clin Cancer Res Date: 2015-10-19 Impact factor: 12.531
Authors: Francesco Panzuto; Maria Rinzivillo; Francesca Spada; Lorenzo Antonuzzo; Toni Ibrahim; Davide Campana; Nicola Fazio; Gianfranco Delle Fave Journal: Pancreas Date: 2017-03 Impact factor: 3.327
Authors: Grace Kong; Jason Callahan; Michael S Hofman; David A Pattison; Tim Akhurst; Michael Michael; Peter Eu; Rodney J Hicks Journal: Eur J Nucl Med Mol Imaging Date: 2016-09-27 Impact factor: 9.236
Authors: Fritz-Line Vélayoudom-Céphise; Pierre Duvillard; Lydia Foucan; Julien Hadoux; Cecile N Chougnet; Sophie Leboulleux; David Malka; Joël Guigay; Diane Goere; Thierry Debaere; Caroline Caramella; Martin Schlumberger; David Planchard; Dominique Elias; Michel Ducreux; Jean-Yves Scoazec; Eric Baudin Journal: Endocr Relat Cancer Date: 2013-08-19 Impact factor: 5.678
Authors: G Kong; M Thompson; M Collins; A Herschtal; M S Hofman; V Johnston; P Eu; M Michael; Rodney J Hicks Journal: Eur J Nucl Med Mol Imaging Date: 2014-05-21 Impact factor: 9.236
Authors: Akua Graf; James Welch; Rashika Bansal; Adel Mandl; Vaishali I Parekh; Craig Cochran; Elliot Levy; Naris Nilubol; Dhaval Patel; Samira Sadowski; Smita Jha; Sunita K Agarwal; Corina Millo; Jenny E Blau; William F Simonds; Lee S Weinstein; Jaydira Del Rivero Journal: J Endocr Soc Date: 2022-08-13
Authors: Hian Liang Huang; Aaron Kian Ti Tong; Sue Ping Thang; Sean Xuexian Yan; Winnie Wing Chuen Lam; Kelvin Siu Hoong Loke; Charlene Yu Lin Tang; Lenith Tai Jit Cheng; Gideon Su Kai Ooi; Han Chung Low; Butch Maulion Magsombol; Wei Ying Tham; Charles Xian Yang Goh; Colin Jingxian Tan; Yiu Ming Khor; Sumbul Zaheer; Pushan Bharadwaj; Wanying Xie; David Chee Eng Ng Journal: Nucl Med Mol Imaging Date: 2019-01-25
Authors: Thomas A Hope; Lisa Bodei; Jennifer A Chan; Ghassan El-Haddad; Nicholas Fidelman; Pamela L Kunz; Josh Mailman; Yusuf Menda; David C Metz; Erik S Mittra; Daniel A Pryma; Diane L Reidy-Lagunes; Simron Singh; Jonathan R Strosberg Journal: J Nucl Med Date: 2020-02 Impact factor: 11.082