Neuroendocrine tumors (NETs) are a diverse group of tumors that often present late
due to nonspecific symptoms. These tumors frequently express somatostatin receptors
(SSRs), which allows for positron emission tomography/computed tomography (PET/CT)
imaging with Ga-68-DOTATATE. In eligible patients, this may then be followed by peptide
receptor radionuclide therapy (PRRT). Here, we report our initial results and experience
with PRRT in a developing country, as one of the first groups to provide this therapy
in South Africa. Eligible patients with confirmed inoperable NETs were recruited prospectively
and treated with Lu-177-DOTATATE. Baseline imaging was performed with either single-photon
emission CT- or PET-based SSR analogs, whereas follow-up was performed with 68Ga-DOTATATE PET/CT 6 months post treatment completion. Interim treatment response
evaluation was based on post therapy imaging of Lu-177-DOTATATE. A total of 48 patients
with a mean age of 58 years were treated with PRRT, of whom 22 (46%) demonstrated
stable disease, 20 (42%) demonstrated a partial response, and 6 (12%) demonstrated
progressive disease. The median progression-free survival (PFS) was 20 months with
an interquartile range (IQR)25%–75%of 4.5–30 months. The median freedom from progression duration was 32 months with
an IQR25%–75%of 25–40 months, and the median overall survival was 10 months with an (IQR)25%–75%of 5–24 months. Our subgroup analysis demonstrated an inverse association between
metabolic tumor volume with PFS, which requires further validation. In conclusion,
PRRT with Lu-177-DOTATATE resulted in a median PFS of 20 months in patients with inoperable
NETs in the absence of significant side effects.
Keywords
LuTate - neuroendocrine tumors - PRRT
