lutetium-lu-177-dotatate and Hematologic-Diseases

It has been shown that a subgroup of patients with differentiated thyroid cancer (DTC) and medullary thyroid carcinoma (MTC) would progress to advanced stages of thyroid cancer. Therefore, the present study was done to systematically review available evidence in order to investigate efficacy and safety of peptide receptor radionuclide therapy (PRRT) in the patients with advanced radioiodine refractory differentiated thyroid cancer (RR-DTC) and metastatic MTC.. For this purpose, relevant studies investigated safety and efficacy of PRRT in the patients with advanced RR-DTC and metastatic MTC were identified by searching Medline (Pubmed, Ovid, and Ebsco), Scopus, Embase, Web of Science, and Cochrane Library databases (from database inception to March 24, 2021). The review was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Searching was done independently by two investigators. Two researchers independently extracted the data and any disagreement was adjudicated by consensus. Quality of the studies was assessed using the tool of case reports/series in systematic reviews.. Among 2284 related papers, 41 papers met the inclusion criteria. A total of 157 patients with RR-DTC were treated with PPRT. Biochemical and objective responses (partial and complete) were observed in 25.3 and 10.5% of patients, respectively. Among 220 patients with metastatic MTC, biochemical and objective responses were observed in 37.2 and 10.6% of the patients, respectively. Forty-six deaths were reported in 95 patients with advanced RR-DTC. In addition, 63 deaths were observed in 144 patients with metastatic MTC. Major side effects were reported in 124 patients treated with. Findings of the study revealed that in the absence of the established treatment for the patients with RR-DTC and metastatic MTC, PRRT could be effective with few adverse events.. PROSPERO registration number: CRD42019125245 .

Topics: Carcinoma, Neuroendocrine; Hematologic Diseases; Humans; Iodine Radioisotopes; Octreotide; Organometallic Compounds; Radiation Injuries; Radiation Tolerance; Radiopharmaceuticals; Renal Insufficiency; Thyroid Neoplasms; Treatment Outcome; Yttrium Radioisotopes

Despite the fact that most gastroenteropancreatic neuroendocrine tumors (GEPNETs) are slow-growing, median overall survival (OS) in patients with liver metastases is 2 to 4 years. In metastatic disease, cytoreductive therapeutic options are limited. A relatively new therapy is peptide receptor radionuclide therapy with the radiolabeled somatostatin analog [(177)Lu-DOTA(0),Tyr(3)]octreotate. Here we report on the toxicity and efficacy of this treatment, performed in over 500 patients.. Patients were treated up to a cumulative dose of 750 to 800 mCi (27.8-29.6 GBq), usually in four treatment cycles, with treatment intervals of 6 to 10 weeks. Toxicity analysis was done in 504 patients, and efficacy analysis in 310 patients.. Any hematologic toxicity grade 3 or 4 occurred after 3.6% of administrations. Serious adverse events that were likely attributable to the treatment were myelodysplastic syndrome in three patients, and temporary, nonfatal, liver toxicity in two patients. Complete and partial tumor remissions occurred in 2% and 28% of 310 GEPNET patients, respectively. Minor tumor response (decrease in size > 25% and < 50%) occurred in 16%. Median time to progression was 40 months. Median OS from start of treatment was 46 months, median OS from diagnosis was 128 months. Compared with historical controls, there was a survival benefit of 40 to 72 months from diagnosis.. Treatment with [(177)Lu-DOTA(0),Tyr(3)]octreotate has few adverse effects. Tumor response rates and progression-free survival compare favorably to the limited number of alternative treatment modalities. Compared with historical controls, there is a benefit in OS from time of diagnosis of several years.

Topics: Adult; Aged; Aged, 80 and over; Carcinoid Tumor; Chemical and Drug Induced Liver Injury; Disease-Free Survival; Female; Gastrointestinal Neoplasms; Hematologic Diseases; Humans; Logistic Models; Male; Middle Aged; Myelodysplastic Syndromes; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Pancreatic Neoplasms; Proportional Hazards Models; Radionuclide Imaging; Radiopharmaceuticals; Risk Assessment; Severity of Illness Index; Time Factors; Treatment Outcome

Peptide receptor radionuclide therapy (PRRT) with (177)Lu-DOTATATE is an efficient new treatment option in patients with neuroendocrine tumors (NETs), with low risk of toxicity. Since the kidneys are critical organs in PRRT, renal function is known to deteriorate after PRRT. We analyzed the decline in glomerular filtration rate (GFR), increase in serum creatinine (SCr), and changes in hemogram parameters between pretherapy and at least 6 months after last cycle post-therapy with (177)Lu-DOTATATE.. Forty-seven patients with NETs received 2-6 cycles of (177)Lu-DOTATATE, leading to a total renal radiation absorbed dose of 12.5 ± 4.1 Gy. All renal dose estimates were calculated with the help of OLINDA/EXM software. All patients were infused with renal protective amino acids during the administration of the radiopharmaceuticals. In this study, we used GFR that was estimated by in vitro method using (99m)Tc-DTPA and SCr to assess renal toxicity.. The patients were administered a mean cumulative activity of 20.1 ± 6.74 GBq of (177)Lu-DOTATATE. There was a significant decrease in GFR from 86.8 ± 15.4 mL/1.73 m(2)/min to 66.1 ± 14.5 mL/1.73 m(2)/min and rise in SCr from 0.86 ± 0.19 mg/dL to 1.0 ± 0.2 mg/dL with treatment. Patients with WHO grade 1 renal toxicity (group 2) at baseline demonstrated an increase in SCr that was significantly higher compared with patients with normal baseline creatinine levels (group 1). No serious acute or remote adverse events were recorded. Self-limiting serious hematological toxicity was observed in 2 patients.. The decline in renal function as measured by in vitro GFR tends to be of greater magnitude in patients with baseline impaired renal function than in patients with preserved renal function after PRRT. Hematologic toxicity is relatively rare and can be managed conservatively when encountered.

Topics: Female; Hematologic Diseases; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Radiation Injuries; Radiopharmaceuticals; Receptors, Peptide