Real‐world efficacy of lutetium peptide receptor radionuclide therapy in patients with neuroendocrine tumours

• Published in: Journal of neuroendocrinology Vol. 34; no. 6; pp. e13138 - n/a
• Main Authors: Almeamar, Hussein, Cullen, Lisa, Murphy, David J., Crowley, Rachel K., Toumpanakis, Christos, Welin, Staffan, O'Shea, Donal, O'Toole, Dermot
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.06.2022
• Subjects: Acute myeloid leukemia; Chronic myeloid leukemia; efficacy; Leukemia; Metastases; Metastasis; Neuroendocrine tumors; neuroendocrine tumours; Patients; Peptides; PRRT; Radiation therapy; safety; Small intestine; Somatostatin; Statistical analysis; Survival; PRRT; neuroendocrine tumours; safety; efficacy
• ISSN: 0953-8194; 1365-2826; 1365-2826
• DOI: 10.1111/jne.13138

Lutetium peptide receptor radio nuclide therapy (Lu‐PRRT) is an effective treatment for progressive, metastatic, somatostatin‐receptor‐positive, well‐differentiated neuroendocrine tumours (WD‐NETs). Here, we report a single centre experience of real‐world efficacy, long‐term side effects, and challenges of this treatment. This was a retrospective analysis. All patients linked with our centre who had Lu‐PRRT were included. Clinicopathological data were analysed using descriptive statistics, Kaplan–Meier, and Cox regression. A total of 45 patients had Lu‐PRRT, of those 30 (67%) were males, and 13 (29%) were more than 65 years old. The primary site was small intestine in 30 (67%) patients, pancreas in seven (16%) patients, and lung in three (7%) patients. The tumor was grade 1 in 15 (35%) patients, grade 2 in 22 (48%) patients, and grade 3 in six (13%) patients. A total of 41 (91%) patients had liver metastasis, and 20 (44%) patients had carcinoid syndrome. Lu‐PRRT was the second‐line therapy in all patients. Krenning's score was 4 in 36 (80%) patients and 3 in nine (20%) patients. The median waiting time to start Lu‐PRRT therapy was 87 days. The median follow‐up was 41 months. A total of 23 (51%) patients had a partial response, 18 (40%) patients had stable disease, and four (9%) patients had progression. None of the patients had a complete response. The median progression‐free survival (PFS) was 38 months (95% CI: 25.8–50.1). The median overall survival (OS) was not reached. Nine patients died during follow‐up (death from any cause). Prior treatment with targeted therapies or high dose somatostatin analogues were negative predictors of Lu‐PRRT outcome (p‐values of < .001 and < .045, respectively). There were two serious haematological toxicities, one patient developed acute myeloid leukaemia (AML), and the other developed chronic myeloid leukaemia (CML). Lu‐PRRT is an effective second‐line treatment for metastatic WD‐NETs. The effect of targeted therapies on Lu‐PRRT outcome was significant and needs to be clarified in further studies.