Journal Article

Peptide Receptor Radionuclide Therapy Improves Survival in Patients Who Progress After Resection of Gastroenteropancreatic Neuroendocrine Tumors

Sherman, Scott K., Howe, James R., Bellizzi, Andrew M., O’Dorisio, Thomas M., Breheny, Patrick J., Dillon, Joseph S., Ear, P. H., Chandrasekharan, Chandrikha, Bushnell, David, Borbon, Luis C., O’Dorisio, M. Sue, Menda, Yusuf

2025

Overview

Background Peptide receptor radionuclide therapy (PRRT) is an effective treatment for advanced gastroenteropancreatic (GEP) neuroendocrine tumors (NETs). We investigated a 2-decade experience with PRRT to determine whether PRRT confers a survival advantage to patients who progress after surgery versus other therapies. Methods We identified patients from our clinic who had resection/cytoreduction of GEP-NETs, then disease progression by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The Kaplan–Meier method assessed progression-free survival (PFS) and overall survival (OS), calculated from progression after surgery (no-PRRT group) or the start of PRRT. Cox regression with time-dependent covariates controlled for immortal time bias and other confounders. Results Overall, 237 patients progressed after surgery; 95 received PRRT and 142 did not. No differences existed in sex, T or N stage, tumor grade/differentiation, primary site, or time to progression; 94% of PRRT patients had metastases at diagnosis versus 77% in the no-PRRT group. Median PFS was longer in the PRRT group versus the no-PRRT group (32.4 vs. 11.0 months, p  < 0.001), as was median OS (49.8 vs. 38.4 months; p  = 0.009). In subgroup analysis, the PRRT group had improved PFS in small bowel NETs and pancreatic NETs. Time-dependent covariate analysis revealed a lower risk of death associated with PRRT (hazard ratio 0.61, p  = 0.028) after adjusting for sex, age, M stage, tumor grade, and primary site. Conclusion Surgical resection and cytoreduction is an effective treatment for patients with GEP-NETs, but most patients with metastatic disease develop recurrent disease. Surgery followed by PRRT after progression conferred superior PFS and OS over no PRRT/other therapies, and is an effective strategy for managing patients with GEP-NETs.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Cytoreduction Surgical Procedures - mortality / Disease Progression / Endocrine Tumors / Female / Follow-Up Studies / Humans / Intestinal Neoplasms - mortality / Intestinal Neoplasms - pathology / Intestinal Neoplasms - radiotherapy / Intestinal Neoplasms - surgery / Lutetium - therapeutic use / Male / Medicine / Medicine & Public Health / Metastases / Middle Aged / Neuroendocrine system / Neuroendocrine tumors / Neuroendocrine Tumors - mortality / Neuroendocrine Tumors - pathology / Neuroendocrine Tumors - radiotherapy / Neuroendocrine Tumors - surgery / Octreotide - analogs & derivatives / Octreotide - therapeutic use / Oncology / Pancreatic Neoplasms - mortality / Pancreatic Neoplasms - pathology / Pancreatic Neoplasms - radiotherapy / Pancreatic Neoplasms - surgery / Patients / Peptides / Prognosis / Radiation therapy / Radioisotopes - therapeutic use / Radiopharmaceuticals - therapeutic use / Receptors, Peptide - metabolism / Retrospective Studies / Sex ratio / Small intestine / Solid tumors / Stomach Neoplasms - mortality / Stomach Neoplasms - pathology / Stomach Neoplasms - radiotherapy / Stomach Neoplasms - surgery / Surgery / Surgical Oncology / Survival / Survival Rate