Treatment with the radiolabeled somatostatin analog [177Lu-DOTA0, Tyr3] octreotate:: Toxicity, efficacy, and survival
Treatment with the radiolabeled somatostatin analog [177Lu-DOTA0, Tyr3] octreotate:: Toxicity, efficacy, and survival
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DOI：
10.1200/jco.2007.15.2553
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发表时间：
2008-05-01
影响因子：
45.3
通讯作者：
Krenning, Eric P.
中科院分区：
文献类型：
--
作者：
Kwekkeboom, Dik J.;de Herder, Wouter W.;Krenning, Eric P.
目的是尽管大多数胃肠道神经内分泌肿瘤（GEPNETS）的增长缓慢，但肝转移患者的总体生存期（OS）为2至4年，这一事实为2至4年。在转移性疾病中，细胞还原性治疗选择有限。相对较新的疗法是肽受体放射性核素疗法，其辐射标记的生长抑素类似物[LU-177-DOTA（0），Tyr（3）]尾酸盐。在这里，我们报告了500多名患者进行此治疗的毒性和功效。患者和方法室的累积剂量为750至800 MCI（27.8-29.6 GBQ），通常在四个治疗周期中，通常具有治疗间隔， 6至10周。在504例患者中进行了毒性分析，并在310例患者中进行了疗效分析。诊断3或4级的毒性毒性发生在3.6％的施用后。可能归因于治疗的严重不良事件是三名患者的骨髓增生性综合征，两名患者的临时，非致命性，肝毒性。在310名GEPNET患者中，有2％和28％发生了完全和部分肿瘤。较小的肿瘤反应（尺寸降低> 25％和<50％）发生在16％。进展的中位时间为40个月。从治疗开始开始的中位OS为46个月，诊断中位OS的中位OS为128个月。与历史对照相比，诊断后有40到72个月的生存益处。与[Lu-177-Dota（0），Tyr（3），抗甲替酸盐的判定治疗几乎没有不利影响。肿瘤反应率和无进展生存率与有限数量的替代治疗方式相比。与历史对照相比，从诊断为几年后的OS有好处。
PurposeDespite 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 [Lu-177-DOTA(0), Tyr(3)] octreotate. Here we report on the toxicity and efficacy of this treatment, performed in over 500 patients.Patients and MethodsPatients 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.ResultsAny 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.ConclusionTreatment with [Lu-177-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.