Somatostatin-based radiopeptide therapy with [177Lu-DOTA]-TOC versus [90Y-DOTA]-TOC in neuroendocrine tumours

• Published in: European journal of nuclear medicine and molecular imaging Vol. 41; no. 2; pp. 214 - 222
• Main Authors: Romer, A., Seiler, D., Marincek, N., Brunner, P., Koller, M. T., Ng, Q. K. T., Maecke, H. R., Müller-Brand, J., Rochlitz, C., Briel, M., Schindler, C., Walter, M. A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2014; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged, 80 and over; Cardiology; Child; Endocrine therapy; Female; Humans; Imaging; Kidney; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroendocrine Tumors - radiotherapy; Neurology; Nuclear Medicine; Octreotide - adverse effects; Octreotide - analogs & derivatives; Octreotide - therapeutic use; Oncology; Original Article; Orthopedics; Peptides; Radiology; Radiopharmaceuticals - adverse effects; Radiopharmaceuticals - therapeutic use; Treatment Outcome; Tumors; Neuroendocrine tumour; Somatostatin; Yttrium; Lutetium; Survival
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-013-2559-8

Purpose Somatostatin-based radiopeptide treatment is generally performed using the β-emitting radionuclides 90 Y or 177 Lu. The present study aimed at comparing benefits and harms of both therapeutic approaches. Methods In a comparative cohort study, patients with advanced neuroendocrine tumours underwent repeated cycles of [ 90 Y-DOTA]-TOC or [ 177 Lu-DOTA]-TOC until progression of disease or permanent adverse events. Multivariable Cox regression and competing risks regression were employed to examine predictors of survival and adverse events for both treatment groups. Results Overall, 910 patients underwent 1,804 cycles of [ 90 Y-DOTA]-TOC and 141 patients underwent 259 cycles of [ 177 Lu-DOTA]-TOC. The median survival after [ 177 Lu-DOTA]-TOC and after [ 90 Y-DOTA]-TOC was comparable (45.5 months versus 35.9 months, hazard ratio 0.91, 95 % confidence interval 0.63–1.30, p  = 0.49). Subgroup analyses revealed a significantly longer survival for [ 177 Lu-DOTA]-TOC over [ 90 Y-DOTA]-TOC in patients with low tumour uptake, solitary lesions and extra-hepatic lesions. The rate of severe transient haematotoxicities was lower after [ 177 Lu-DOTA]-TOC treatment (1.4 vs 10.1 %, p  = 0.001), while the rate of severe permanent renal toxicities was similar in both treatment groups (9.2 vs 7.8 %, p  = 0.32). Conclusion The present results revealed no difference in median overall survival after [ 177 Lu-DOTA]-TOC and [ 90 Y-DOTA]-TOC. Furthermore, [ 177 Lu-DOTA]-TOC was less haematotoxic than [ 90 Y-DOTA]-TOC.