lutetium-lu-177-dotatate and Bronchial-Neoplasms

Bronchial carcinoids are uncommon tumors accounting for 20 to 30% of all neuroendocrine tumors and about 1-2% of all cancers of pulmonary origin. Bronchial carcinoids are well-differentiated neuroendocrine tumors and have a favorable survival outcome when compared with other subtypes of lung cancers. Treatment of bronchial carcinoids is not simple owing to intricacy of symptom presentation and heterogeneity of disease biology. Successful treatment of patients requires a multimodality approach. Resection is curative in the majority of patients with localized tumors and adjuvant treatment is not routinely recommended. Multiple options for systemic therapy exist for patients with advanced disease. To date, very few randomized clinical trials have been done, partly owing to the relative rarity of this malignancy. Somatostatin analogs (SSAs) are reasonable first-line choice for patients with tumors expressing somatostatin receptors. Everolimus is an appropriate first-line choice for somatostatin receptor negative tumors and for any patients with progressive disease. PRRT can also be considered for progressive tumors expressing somatostatin receptors. Based on retrospective series, cytotoxic chemotherapy can be selected in patients with progressive tumors, primarily when cytoreduction is needed. Herein, we will discuss evidence supporting the role of adjuvant and systemic treatment therapies for those with bronchial carcinoid tumors by focusing on various studies.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bronchial Neoplasms; Capecitabine; Carcinoid Tumor; Chemotherapy, Adjuvant; Cisplatin; Etoposide; Everolimus; Humans; Immune Checkpoint Inhibitors; Lung Neoplasms; Lymph Node Excision; Molecular Targeted Therapy; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Pneumonectomy; Protein Kinase Inhibitors; Radiopharmaceuticals; Receptors, Somatostatin; Somatostatin; Temozolomide; Watchful Waiting

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bronchial Neoplasms; Female; Humans; Intestinal Neoplasms; Kaplan-Meier Estimate; Leukemia; Male; Middle Aged; Myelodysplastic Syndromes; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Outcome Assessment, Health Care; Pancreatic Neoplasms; Radiopharmaceuticals; Stomach Neoplasms; Time Factors; Treatment Outcome

Regular therapy with the radiolabeled somatostatin analog (177)Lu-octreotate (22.2-29.6 GBq) in patients with gastroenteropancreatic or bronchial neuroendocrine tumors results in tumor remission in 46% of patients, including minor response. We present the effects of additional therapy with (177)Lu-octreotate in patients in whom progressive disease developed after an initial benefit from regular therapy.. Thirty-three patients with progressive disease after an initial radiologic or clinical response were treated with additional cycles of (177)Lu-octreotate. The intended cumulative dose of additional therapy was 14.8 GBq in 2 cycles. Responses were evaluated using Southwest Oncology Group criteria, including minor response (tumor size reduction of >or=25% and <50%).. Median time to progression (TTP) after regular therapy was 27 mo. In 4 patients, the intended cumulative dose was not achieved (2 had progressive disease, 2 had long-lasting thrombocytopenia). Hematologic toxicity grade 3 was observed in 4 patients, and grade 4, in 1. The median follow-up time was 16 mo (range, 1-40 mo). No kidney failure or myelodysplastic syndrome was observed. Renewed tumor regression was observed in 8 patients (2 partial remission, 6 minor response), and 8 patients had stable disease. Median TTP was 17 mo. Treatment outcome was less favorable in patients with a short TTP after regular cycles. Treatment effects in patients with pancreatic neuroendocrine tumors were similar to those in patients with other gastroenteropancreatic neuroendocrine tumors.. Most patients tolerated additional cycles with (177)Lu-octreotate well. None developed serious delayed adverse events. Additional cycles with (177)Lu-octreotate can have antitumor effects, but effects were less than for the regular cycles. This may be because of a worse clinical condition, more extensive tumor burden, or changed tumor characteristics. We conclude that this salvage therapy can be effective and is safe.

Topics: Adult; Aged; Bronchial Neoplasms; Chromogranin A; Disease Progression; Humans; Middle Aged; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Salvage Therapy; Treatment Outcome