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Highly favourable outcomes with peptide receptor radionuclide therapy (PRRT) for metastatic rectal neuroendocrine neoplasia (NEN)

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Abstract

Purpose

Rectal neuroendocrine neoplasia (NEN) is more common than other NEN origins, but is less commonly metastatic. However, when present, distant disease carries a particularly poor prognosis. Evidence guiding optimal treatment of such patients is lacking. We assessed PRRT outcomes in patients with somatostatin receptor (SSTR) positive metastatic rectal NEN from two referral centres.

Methods

Patients treated with PRRT were retrospectively reviewed. Morphologic (RECIST 1.1), SSTR imaging responses and toxicity were assessed 3 months post-PRRT. Kaplan-Meier estimate was used to determine progression-free survival (PFS) and overall survival (OS) from start of PRRT.

Results

Twenty-seven consecutive patients (M = 20, age 31-81 years) were reviewed. The majority (70%) had ENETs grade 2 disease (19 patients), three had Grade 3, one Grade 1, and four not documented. Overall, 63% (10/16 patients with available FDG PET/CT) had FDG avid disease. Twenty-six patients were treated for disease progression. Most had 177Lu-DOTA-octreotate with median cumulative activity of 30 GBq, median four cycles. 14 patients had radiosensitising chemotherapy (5FU or capecitabine). At 3 months post-PRRT, CT disease control rate (DCR) was 96%: partial response was observed in 70% (19/27) and stable disease in 26%. All but one had partial SSTR imaging response. The median PFS was 29 months. Ten patients died, with median overall survival 81 months with a median follow-up of 67 months. Seventeen patients had further treatments after initial PRRT (10 had further cycles of PRRT). Three patients had grade 3 lymphopenia, without significant renal toxicity, MDS or leukaemia.

Conclusion

Our results indicate high efficacy and morphologic responses with minimal toxicity and very encouraging survival from PRRT in patients with metastatic rectal NEN despite the adverse prognostic features of this cohort. Further prospective PRRT trials are warranted in this subgroup.

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Author notes

  1. Grace Kong and Simona Grozinsky-Glasberg contributed equally to this work.

Authors and Affiliations

  1. Centre for Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia

    Grace Kong, Michael S. Hofman, Tim Akhurst & Rodney J. Hicks

  2. Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Grace Kong, Michael S. Hofman, Tim Akhurst, Michael Michael & Rodney J. Hicks

  3. Neuroendocrine Tumour Unit, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel

    Simona Grozinsky-Glasberg & David J. Gross

  4. Oncology Department and Radiation Therapy Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Amichay Meirovitz & Ofra Maimon

  5. Nuclear Medicine Department, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel

    Yodphat Krausz & Jeremy Godefroy

  6. Divison Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Michael Michael

  7. The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Parkville, VIC, Australia

    Rodney J. Hicks

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  1. Grace Kong
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Correspondence to Grace Kong.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent for treatment was obtained from all individual participants included in the study.

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Kong, G., Grozinsky-Glasberg, S., Hofman, M.S. et al. Highly favourable outcomes with peptide receptor radionuclide therapy (PRRT) for metastatic rectal neuroendocrine neoplasia (NEN). Eur J Nucl Med Mol Imaging 46, 718–727 (2019). https://doi.org/10.1007/s00259-018-4196-8

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