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Safety, efficacy and kidney doses of [Y-90]DOTA-TATE therapy of neuroendocrine tumors (NET)

¹ Nuclear Medicine; ² Internal Medicine, University of Munich, Munich, Germany

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Objectives: [Y-90]DOTA-TOC is frequently used for radiopeptide therapy in pts with somatostatin receptor subtype 2 (SSTR2) positive NET. Less data exist on [Y-90]DOTA-TATE, even though it has a 7-fold higher affinity for the SSTR2 compared to DOTA-TOC. Therefore, we evaluated safety, efficacy and kidney doses of [Y-90]DOTA-TATE treatment in NET pts.

Methods: 20 pts with metastasized NET and increased [Ga-68]DOTA-TATE uptake were treated with one (n=16) or two (n=4, interval 3 months) cyles of 3.7 GBq [Y-90]DOTA-TATE (co-injection of 370 MBq [In-111]DOTA-TATE for dosimetry, amino acids for nephroprotection). Whole body scans and blood samples were taken 1, 24, 48 and 72h p.i. Tumor markers, lab parameters, tubular extraction fraction (TER), glomerular filtration rate (GFR) and [Ga-68]DOTA-TATE PET/CT were evaluated before (n=24) and 3 months after each cycle (n=17).

Results: Disease regression was seen in 11/17 eligible cases (decrease of mean SUVmax: 14.6±4.6 to 9.4±2.3 in PET (p<0.001), additional size reduction in CT in 4 pts, drop of tumor markers in 5/14 cases), stable disease in 5 and progression in one pt. In 7/8 pts preexisting diarrhea and flush ameliorated. No acute nephrotoxicity was observed with mean values for TER, GFR, serum creatinine, urea and cystatine C remaining stable. Mean kidney dose was 2.4±0.6 Gy/GBq and thus far below toxic thresholds, however, individual doses did not correlate with pretherapeutic TER, GFR or renal uptake (SUVmean) in PET.

Conclusions: [Y-90]DOTA-TATE is a powerful and safe therapeutic agent for NET. However, individual dosimetry seems necessary, since kidney doses varied inter- and intraindividually and none of the pretherapeutically assessed functional parameters allowed to reliably predict renal radiation exposure.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Pöpperl, G. Articles by Bartenstein, P. PubMed Articles by Pöpperl, G. Articles by Bartenstein, P.