Regular therapy with the radiolabeled somatostatin analog177Lu-octreotate (22.2-29.6 GBq) in patients with gastroenteropancreatic or bronchial neuroendocrine tumors results in tumor remission in 46% of patients, including minor response. We present the effects of additional therapy with177Lu-octreotate in patients in whom progressive disease developed after an initial benefit from regular therapy. Methods: Thirty-three patients with progressive disease after an initial radiologic or clinical response were treated with additional cycles of177Lu-octreotate. The intended cumulative dose of additional therapy was 14.8 GBq in 2 cycles. Responses were evaluated using Southwest Oncology Group criteria, including minor response (tumor size reduction of ≥25% and <50%). Results: Median time to progression (TTP) after regular therapy was 27 mo. In 4 patients, the intended cumulative dose was not achieved (2 had progressive disease, 2 had long-lasting thrombocytopenia). Hematologic toxicity grade 3 was observed in 4 patients, and grade 4, in 1. The median follow-up time was 16 mo (range, 1-40 mo). No kidney failure or myelodysplastic syndrome was observed. Renewed tumor regression was observed in 8 patients (2 partial remission, 6 minor response), and 8 patients had stable disease. Median TTP was 17 mo. Treatment outcome was less favorable in patients with a short TTP after regular cycles. Treatment effects in patients with pancreatic neuroendocrine tumors were similar to those in patients with other gastroenteropancreatic neuroendocrine tumors. Conclusion: Most patients tolerated additional cycles with177Lu-octreotate well. None developed serious delayed adverse events. Additional cycles with177Luoctreotate can have antitumor effects, but effects were less than for the regular cycles. This may be because of a worse clinical condition, more extensive tumor burden, or changed tumor characteristics. We conclude that this salvage therapy can be effective and is safe. Copyright

177, Additional therapy, Carcinoid, Lu-octreotate, Neuroendocrine tumors, Salvage therapy,
The Journal of Nuclear Medicine
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Erasmus MC: University Medical Center Rotterdam

van Essen, M, Krenning, E.P, Kam, B.L, de Herder, W.W, Feelders, R.A, & Kwekkeboom, D. (2010). Salvage therapy with177Lu-octreotate in patients with bronchial and gastroenteropancreatic neuroendocrine tumors. The Journal of Nuclear Medicine, 51(3), 383–390. doi:10.2967/jnumed.109.068957