Peptide receptor radionuclide therapy for aggressive pituitary tumors: a monocentric experience

• Published in: Endocrine Connections Vol. 8; no. 5; pp. 528 - 535
• Main Authors: Giuffrida, G, Ferraù, F, Laudicella, R, Cotta, O R, Messina, E, Granata, F, Angileri, F F, Vento, A, Alibrandi, A, Baldari, S, Cannavò, S
• Format: Journal Article
• Language: English
• Published: England Bioscientifica Ltd 01.05.2019; Bioscientifica
• Subjects: aggressive pituitary adenomas; peptide receptor radionuclide therapy; pituitary tumors; PRRT; PRRT; aggressive pituitary adenomas; pituitary tumors; peptide receptor radionuclide therapy
• ISSN: 2049-3614; 2049-3614
• DOI: 10.1530/EC-19-0065

In aggressive pituitary tumors (PT) showing local invasion or growth/recurrence despite multimodal conventional treatment, temozolomide (TMZ) is considered a further therapeutic option, while little data are available on peptide receptor radionuclide therapy (PRRT). We analyzed PRRT effectiveness, safety and long-term outcome in three patients with aggressive PT, also reviewing the current literature. Patient #1 (F, giant prolactinoma) received five cycles (total dose 37 GBq) of 111In-DTPA-octreotide over 23 months, after unsuccessful surgery and long-term dopamine-agonist treatment. Patient #2 (M, giant prolactinoma) underwent two cycles (12.6 GBq) of 177Lu-DOTATOC after multiple surgeries, radiosurgery and TMZ. In patient #3 (F, non-functioning PT), five cycles (29.8 GBq) of 177Lu-DOTATOC followed five surgeries, radiotherapy and TMZ. Eleven more cases of PRRT-treated aggressive PT emerged from literature. Patient #1 showed tumor shrinkage and visual/neurological amelioration over 8-year follow-up, while the other PTs continued to grow causing blindness and neuro-cognitive disorders (patient #2) or monolateral amaurosis (patient #3). No adverse effects were reported. Including the patients from literature, 4/13 presented tumor shrinkage and clinical/biochemical improvement after PRRT. Response did not correlate with patients’ gender or age, neither with used radionuclide/peptide, but PRRT failure was significantly associated with previous TMZ treatment. Overall, adverse effects occurred only in two patients. PRRT was successful in 1/3 of patients with aggressive PT, and in 4/5 of those not previously treated with TMZ, representing a safe option after unsuccessful multimodal treatment. However, at present, considering the few data, PRRT should be considered only in an experimental setting.