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Treatment With the Radiolabeled Somatostatin Analog [¹⁷⁷Lu-DOTA⁰,Tyr³]Octreotate: Toxicity, Efficacy, and Survival

Dik J. Kwekkeboom, Wouter W. de Herder, Boen L. Kam, Casper H. van Eijck, Martijn van Essen, Peter P. Kooij, Richard A. Feelders, Maarten O. van Aken, Eric P. Krenning

From the Departments of Nuclear Medicine, Internal Medicine, and Surgery, Erasmus Medical Center, Rotterdam, the Netherlands

Corresponding author: Dik J. Kwekkeboom, MD, Department of Nuclear Medicine, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands; e-mail: d.j.kwekkeboom{at}erasmusmc.nl

Purpose: Despite the fact that most gastroenteropancreatic neuroendocrine tumors (GEPNETs) are slow-growing, median overall survival (OS) in patients with liver metastases is 2 to 4 years. In metastatic disease, cytoreductive therapeutic options are limited. A relatively new therapy is peptide receptor radionuclide therapy with the radiolabeled somatostatin analog [¹⁷⁷Lu-DOTA⁰,Tyr³]octreotate. Here we report on the toxicity and efficacy of this treatment, performed in over 500 patients.

Patients and Methods: Patients were treated up to a cumulative dose of 750 to 800 mCi (27.8-29.6 GBq), usually in four treatment cycles, with treatment intervals of 6 to 10 weeks. Toxicity analysis was done in 504 patients, and efficacy analysis in 310 patients.

Results: Any hematologic toxicity grade 3 or 4 occurred after 3.6% of administrations. Serious adverse events that were likely attributable to the treatment were myelodysplastic syndrome in three patients, and temporary, nonfatal, liver toxicity in two patients. Complete and partial tumor remissions occurred in 2% and 28% of 310 GEPNET patients, respectively. Minor tumor response (decrease in size > 25% and < 50%) occurred in 16%. Median time to progression was 40 months. Median OS from start of treatment was 46 months, median OS from diagnosis was 128 months. Compared with historical controls, there was a survival benefit of 40 to 72 months from diagnosis.

Conclusion: Treatment with [¹⁷⁷Lu-DOTA⁰,Tyr³]octreotate has few adverse effects. Tumor response rates and progression-free survival compare favorably to the limited number of alternative treatment modalities. Compared with historical controls, there is a benefit in OS from time of diagnosis of several years.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.