Long-term outcome of “Sandwich” chemo-PRRT: a novel treatment strategy for metastatic neuroendocrine tumors with both FDG- and SSTR-avid aggressive disease

Objective The primary aims of this study were to evaluate the long-term outcome of a “sandwich chemo-PRRT (SCPRRT)” regimen with regard to therapeutic response rate, progression-free survival (PFS), and overall survival (OS) rates in metastatic neuroendocrine tumors (NETs) with both somatostatin rec...

Full description

Saved in:
Bibliographic Details
Published in:European journal of nuclear medicine and molecular imaging 2021-03, Vol.48 (3), p.913-923
Main Authors: Parghane, Rahul V., Ostwal, Vikas, Ramaswamy, Anant, Bhandare, Manish, Chaudhari, Vikram, Talole, Sanjay, Shrikhande, Shailesh V., Basu, Sandip
Format: Article
Language:English
Subjects:
Adverse events
Algorithms
Anemia
Cardiology
Chemotherapy
Criteria
Disease control
Evaluation
Imaging
Leukopenia
Medical imaging
Medicine
Medicine & Public Health
Metastases
Metastasis
Neuroendocrine tumors
Nuclear Medicine
Oncology
Original Article
Orthopedics
Patients
Quality of life
Radiation therapy
Radioisotopes
Radiology
Receptors
Signs and symptoms
Somatostatin
Somatostatin receptors
Survival
Temozolomide
Theragnostic
Thrombocytopenia
Toxicity
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective The primary aims of this study were to evaluate the long-term outcome of a “sandwich chemo-PRRT (SCPRRT)” regimen with regard to therapeutic response rate, progression-free survival (PFS), and overall survival (OS) rates in metastatic neuroendocrine tumors (NETs) with both somatostatin receptor (SSTR)– and fluorodeoxyglucose (FDG)-avid aggressive disease. Additionally, health-related quality of life (HRQoL) scales, clinical toxicity, and association of PFS and disease control rate (DCR) with various variables were also evaluated. Materials and methods A total of 38 patients of the aforementioned cohort, who received SCPRRT (at least 2 cycles of each PRRT and chemotherapy) at our institute between January 2012 and December 2018, were included and analyzed in this retrospective study. Between two cycles of 177 Lu-DOTATATE peptide receptor radionuclide therapy (PRRT), two cycles of oral capecitabine and temozolomide (CAPTEM) were sandwiched. Therapeutic responses following SCPRRT were assessed by using pre-defined criteria. PFS and OS after first SCPRRT were determined. Eastern Cooperative Oncology Group (ECOG) and Karnofsky score were used for evaluation of HRQoL before and after SCPPRT in all 38 patients. Any adverse events were graded according to the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0) of the National Cancer Institute. Associations of PFS and DCR with various variables were evaluated. Results Response (complete response and partial response) to SCPRRT was seen in 28 patients (73%), 15 patients (39%), and 16 patients (42%) on symptomatic, biochemical, and molecular imaging response evaluation criteria respectively. A total of 17 patients (45%) had anatomical imaging response with DCR of 84% based upon the RECIST 1.1 criteria. Pre-therapy mean ECOG and KPS was 2.0 and 68, which changed to 1.0 and 75 respectively following SCPRRT. Long-term follow-up data was available and ranged from 12 to 65 months after the first SCPRRT. Median PFS and OS were not reached at a median follow-up of 36 months. An estimated PFS rate of 72.5% and OS rate of 80.4% was found at 36 months. Longer PFS was dependent upon high SSTR uptake and number of CAPTEM cycle (≥ 7 cycles), absence of skeletal metastasis, and no previous external beam radiotherapy (EBRT) exposure with significant P value. Higher DCR was dependent upon absence of skeletal metastasis with significant P value. SCPRRT was tolerated well with none developing grade 4 hema
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-020-05004-5