Nierenfunktion und Peptid-Rezeptor-Radionuklid-Therapie (PRRT)

Zusammenfassung

Die Radionuklidrezeptortherapie (PRRT) mit 90-Yttrium oder 177-Lutetium gekoppelten Somatostatinanaloga ist eine der systemischen und antitumorösen Therapieoptionen bei Patienten mit gastroenteropankreatischen, neuroendokrinen Tumoren (GEP-NET). Eine physiologische Anreicherung des Radiopharmazeutikum akkumuliert sich in den Nieren, die somit die dosiskritischen Organe für eine PRRT darstellen. Eine Verminderung der Nierenfunktion bis hin zur terminalen Niereninsuffizienz (TN) wurde nach PRRT mit ⁹⁰Y-1,4,7,10-tetraazacyclododecan-N,N′,N′′,N′′′-tetraessigsäure (DOTA) Tyr3-Octreotid (⁹⁰Y-DOTATOC) beobachtet. Diese Arbeit versucht, die aktuelle Datenlage zum Mechanismus der PRRT- induzierten Nephrotoxizität und die etablierten Methoden der Nephroprotektion darzustellen.

Abstract

The peptide receptor radionuclide therapy (PRRT) using 90-Yttrium or 177-Lutetium labelled somatostatin analog is one of the systemic antitumor therapy options for gastroenteropancreatic neuroendocrine tumors. These radiolabeled somatostatin analogues get excreted primarily through the kidneys making it the critical organ for PRRT. Terminal kidney insufficiency has been reported with ⁹⁰Y-DOTATOC. This manuscript tries to bring together the actual facts related to the PRRT related nephrotoxicity and the methods to reduce the kidney damage.

Schlüsselwörter

PRRT - neuroendokrine Tumoren - Nephrotoxizität - 90-Yttrium - 177-Lutetium

Key words

PRRT - neuroendocrine tumor - nephrotoxicity - 90-Yttrium - 177-Lutetium

• Literatur

• 1 Barone R, Borson-Chazot F, Valkema R et al. Patient-specific dosimetry in predicting renal toxicity with (90)Y-DOTATOC: relevance of kidney volume and dose rate in finding a dose-effect relationship. J Nucl Med 2005; 46 (Suppl. 01) S99-S106
• 2 Beauregard JM, Hofman MS, Kong G et al. The tumour sink effect on the biodistribution of (68)Ga-DOTA-octreotate: implications for peptide receptor radionuclide therapy. Eur J Nucl Med Mol Imaging 2011; (Epub ahead of print)
• 3 Bodei L, Cremonesi M, Ferrari M et al. Long-term evaluation of renal toxicity after peptide receptor radionuclide therapy with 90Y-DOTATOC and 177Lu-DOTATATE: the role of associated risk factors. Eur J Nucl Med Mol Imaging 2008; 35: 1847-1856
• 4 Cybulla M, Weiner SM, Otte A. 2001; End-stage renal disease after treatment with 90Y-DOTATOC. Eur J Nucl Med 2001; 28: 1552-1554
• 5 de Jong M, Rolleman EJ, Bernard BF et al. Inhibition of renal uptake of indium-111-DTPA-octreotide in vivo. J Nucl Med 1996; 37: 1388-1392
• 6 Emami B, Lyman J, Brown A et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21: 109-122
• 7 Imhof A, Brunner P, Marincek N et al. Response, survival, and long-term toxicity after therapy with the radiolabeled somatostatin analogue [90Y-DOTA]-TOC in metastasized neuroendocrine cancers. J Clin Oncol 2011; 29: 2416-2423
• 8 Kaemmerer D, Prasad V, Daffner W et al. Neoadjuvant peptide receptor radionuclide therapy for an inoperable neuroendocrine pancreatic tumor. World J Gastroenterol 2009; 15: 5867-5870
• 9 Kwekkeboom DJ, de Herder WW, Kam BL et al. Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0,Tyr3]octreotate: toxicity, efficacy, and survival. J Clin Oncol 2008; 26: 2124-2130
• 10 Kwekkeboom DJ, Krenning EP, Lebtahi R et al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: peptide receptor radionuclide therapy with radiolabeled somatostatin analogs. Neuroendocrinology 2009; 90: 220-226
• 11 Melis M, Bijster M, de Visser M et al. Dose-response effect of Gelofusine on renal uptake and retention of radiolabelled octreotate in rats with CA20948 tumours. Eur J Nucl Med Mol Imaging 2009; 36: 1968-1976
• 12 Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13 715 carcinoid tumors. Cancer 2003; 97: 934-959
• 13 Modlin IM, Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer 1997; 79: 813-829
• 14 Otte A, Herrmann R, Heppeler A et al. Yttrium-90 DOTATOC: first clinical results. Eur J Nucl Med 1999; 26: 1439-1447
• 15 Paganelli G, Bodei L, Handkiewicz J et al. 90Y-DOTA-D-Phe1-Try3-octreotide in therapy of neuroendocrine malignancies. Biopolymers 2002; 66: 393-398
• 16 Pellikka PA, Tajik AJ, Khandheria BK et al. Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients. Circulation 1993; 87: 1188-1196
• 17 Pfeifer AK, Gregersen T, Gronbaek H et al. Peptide receptor radionuclide therapy with (90)Y-DOTATOC and (177)Lu-DOTATOC in advanced neuroendocrine tumors: results from a Danish cohort treated in Switzerland. Neuroendocrinology 2011; 93: 189-196
• 18 Rimpler A, Barth I, Baum RB et al. Beta radiation exposure of staff during and after therapies with 90Y-labelled substances. Radiat Prot Dosimetry 2008; 131: 73-79
• 19 Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1977; 1: 466-469
• 20 Rolleman EJ, Kooij PP, de Herder WW et al. Somatostatin receptor subtype 2-mediated uptake of radiolabelled somatostatin analogues in the human kidney. Eur J Nucl Med Mol Imaging 2007; 34: 1854-1860
• 21 Rolleman EJ, Krenning EP, Bernard BF et al. Long-term toxicity of [(177)Lu-DOTA (0),Tyr (3)]octreotate in rats. Eur J Nucl Med Mol Imaging 2007; 34: 219-227
• 22 Rolleman EJ, Valkema R, de Jong M et al. Safe and effective inhibition of renal uptake of radiolabelled octreotide by a combination of lysine and arginine. Eur J Nucl Med Mol Imaging 2003; 30: 9-15
• 23 Shahid M, Francis J, Majid DS. Tumor necrosis factor-alpha induces renal vasoconstriction as well as natriuresis in mice. Am J Physiol Renal Physiol 2008; 295: F1836-F1844
• 24 Trejtnar F, Novy Z, Petrik M et al. In vitro comparison of renal handling and uptake of two somatostatin receptor-specific peptides labeled with indium-111. Ann Nucl Med 2008; 22: 859-867
• 25 Valkema R, Pauwels SA, Kvols LK et al. Long-term follow-up of renal function after peptide receptor radiation therapy with (90)Y-DOTA(0),Tyr(3)-octreotide and (177)Lu-DOTA(0), Tyr(3)-octreotate. J Nucl Med 2005; 46 (Suppl. 01) S83-S91
• 26 Vegt E, de Jong M, Wetzels JF et al. Renal toxicity of radiolabeled peptides and antibody fragments: mechanisms, impact on radionuclide therapy, and strategies for prevention. J Nucl Med 2010; 51: 1049-1058
• 27 Vegt E, Wetzels JF, Russel FG et al. Renal uptake of radiolabeled octreotide in human subjects is efficiently inhibited by succinylated gelatin. J Nucl Med 2006; 47: 432-436
• 28 Waldherr C, Pless M, Maecke HR et al. The clinical value of [90Y-DOTA]-D-Phe1-Tyr3-octreotide (90Y-DOTATOC) in the treatment of neuroendocrine tumours: a clinical phase II study. Ann Oncol 2001; 12: 941-945
• 29 Waldherr C, Pless M, Maecke HR et al. Tumor response and clinical benefit in neuroendocrine tumors after 7.4 GBq (90)Y-DOTATOC. J Nucl Med 2002; 43: 610-616
• 30 Wehrmann C, Senftleben S, Zachert C et al. Results of individual patient dosimetry in peptide receptor radionuclide therapy with 177Lu DOTA-TATE and 177Lu DOTA-NOC. Cancer Biother Radiopharm 2007; 22: 406-416