Journal Article

Long-term results of PRRT in advanced bronchopulmonary carcinoid

Bodei, Lisa, Galetta, Domenico, Fazio, Nicola, Colandrea, Marzia, Gilardi, Laura, Tinelli, Carmine, Baio, Silvia Melania, Paganelli, Giovanni, Mariniello, Annapaola, Valmadre, Giuseppe, Papi, Stefano, Grana, Chiara Maria

2016

Overview

Purpose Peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumours (NET) has been explored for almost two decades, but there are still few trials that have exclusively investigated well-differentiated and moderately differentiated NET arising from the respiratory tree. Thus, the aim of this study was to explore the outcome in patients affected by bronchopulmonary carcinoid (BPC) following PRRT. Methods We retrospectively analysed 114 patients with advanced stage BPC consecutively treated with PRRT at the European Institute of Oncology, Milan, from 1997 to 2012 and followed until October 2014. The objective responses, overall survival (OS) and progression-free survival (PFS) were rated, and three different PRRT protocols ( 90 Y-DOTATOC vs. 177 Lu-DOTATATE vs. 90 Y-DOTATOC +  177 Lu-DOTATATE) were compared with regard to their efficacy and tolerability. Results The median OS (evaluated in 94 of the 114 patients) was 58.8 months. The median PFS was 28.0 months. The 177 Lu-DOTATATE protocol resulted in the highest 5-year OS (61.4 %). Morphological responses (partial responses + minor responses) were obtained in 26.5 % of the cohort and were associated with longer OS and PFS. The 90 Y-DOTATOC +  177 Lu-DOTATATE protocol provided the highest response rate (38.1 %). Adverse events were mild in the majority of patients. However, haematological toxicity negatively affected survival. No severe (grade 3/4) serum creatinine increase was observed. Patients treated with 90 Y-DOTATOC alone more frequently showed a mild/moderate decrease in renal function. In patients treated with chemotherapy before PRRT had a shorter OS and PFS, and a higher risk of developing nephrotoxicity. Conclusion In a large cohort of patients with advanced BPC treated in a “real-world” scenario and followed up for a median of 45.1 months (range 2 – 191 months), PRRT proved to be promising in prolonging survival and delaying disease progression. Despite the potential selection biases, considering the risk-benefit ratio, 177 Lu-DOTATATE monotherapy seems the best option for PRRT. Our results indicate that the use of PRRT in earlier stages of the disease could provide a more favorable outcome.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Aged / Carcinoid Tumor - radiotherapy / Carcinoma, Neuroendocrine - radiotherapy / Cardiology / Cohort Studies / Creatinine - blood / Data Collection / Disease Progression / Disease-Free Survival / Europe / Female / Follow-Up Studies / Humans / Imaging / Lung cancer / Lutetium - chemistry / Male / Medicine / Medicine & Public Health / Middle Aged / Neoplasm Recurrence, Local / Neuroendocrine Tumors - radiotherapy / Nuclear Medicine / Octreotide - analogs & derivatives / Octreotide - chemistry / Odds Ratio / Oncology / Organometallic Compounds - chemistry / Original Article / Orthopedics / Patients / Peptides / Radiation therapy / Radioimmunotherapy / Radioisotopes - chemistry / Radiology / Radiopharmaceuticals - therapeutic use / Receptors, Peptide - chemistry / Retrospective Studies / Treatment Outcome / Tumors