Publicaciones científicas

Efficacy of [177Lu]Lu-DOTATATE in metastatic neuroendocrine neoplasms of different locations: data from the SEPTRALU study

06-mar-2023 | Revista: European Journal of Nuclear Medicine and Molecular Imaging

Mercedes Mitjavila  1 , Paula Jimenez-Fonseca  2 , Pilar Belló  3 , Virginia Pubul  4 , Juan Carlos Percovich  5 , Amparo Garcia-Burillo  6 , Jorge Hernando  7 , Javier Arbizu  8 , Emilia Rodeño  9 , Montserrat Estorch  10 , Belén Llana  11 , Maribel Castellón  12 , Lina García-Cañamaque  13 , Pablo Gajate  14 , Maria Carmen Riesco  15 , Maria Begoña Miguel  16 , David Balaguer-Muñoz  17 , Ana Custodio  18 , Juana María Cano  19 , Alexandra Repetto  20 , Pilar Garcia-Alonso  21 , Maria Angustias Muros  22 , Jose Luis Vercher-Conejero  23 , Alberto Carmona-Bayonas  24

Background: Peptide receptor radionuclide therapy (PRRT) is one of the most promising therapeutic strategies in neuroendocrine neoplasms (NENs). Nevertheless, its role in certain tumor sites remains unclear.

This study sought to elucidate the efficacy and safety of [177Lu]Lu-DOTATATE in NENs with different locations and evaluate the effect of the tumor origin, bearing in mind other prognostic variables.

Advanced NENs overexpressing somatostatin receptors (SSTRs) on functional imaging, of any grade or location, treated at 24 centers were enrolled. The protocol consisted of four cycles of 177Lu-DOTATATE 7.4 GBq iv every 8 weeks (NCT04949282).

Results: The sample comprised 522 subjects with pancreatic (35%), midgut (28%), bronchopulmonary (11%), pheochromocytoma/ paraganglioma (PPGL) (6%), other gastroenteropancreatic (GEP) (11%), and other non-gastroenteropancreatic (NGEP) (9%) NENs. The best RECIST 1.1 responses were complete response, 0.7%; partial response, 33.2%; stable disease, 52.1%; and tumor progression, 14%, with activity conditioned by the tumor subtype, but with benefit in all strata.

Median progression-free survival (PFS) was 31.3 months (95% CI, 25.7-not reached [NR]) in midgut, 30.6 months (14.4-NR) in PPGL, 24.3 months (18.0-NR) in other GEP, 20.5 months (11.8-NR) in other NGEP, 19.8 months (16.8-28.1) in pancreatic, and 17.6 months (14.4-33.1) in bronchopulmonary NENs. [177Lu]Lu-DOTATATE exhibited scant severe toxicity.

Conclusion: This study confirms the efficacy and safety of [177Lu]Lu-DOTATATE in a wide range of SSTR-expressing NENs, regardless of location, with clinical benefit and superimposable survival outcomes between pNENs and other GEP and NGEP tumor subtypes different from midgut NENs.

CITA DEL ARTÍCULO  Eur J Nucl Med Mol Imaging. 2023 Mar 6. doi: 10.1007/s00259-023-06166-8