TY - JOUR
T1 - Induction therapy with 177Lu-DOTATATE procures long-term survival in locally advanced or oligometastatic pancreatic neuroendocrine neoplasm patients
AU - Minczeles, Noémie S.
AU - van Eijck, Casper H. J.
AU - van Gils, Marjon J.
AU - van Velthuysen, Marie-Louise F.
AU - Nieveen van Dijkum, Els J. M.
AU - Feelders, Richard A.
AU - de Herder, Wouter W.
AU - Brabander, Tessa
AU - Hofland, Johannes
N1 - Funding Information: Wouter W. de Herder has received speaker fees from Novartis and Ipsen and received compensation from Novartis and Ipsen for service on advisory boards. Richard A. Feelders has received research grants from Strongbridge, Corcept, and Recordati and consultancy fees from Corcept, Recordati, Ipsen, and HRA Pharma. Tessa Brabander has received speaker fees from Novartis and Ipsen and received compensation from Novartis for service on advisory board. Johannes Hofland has received speaker fees from Ipsen and received compensation from Novartis and Ipsen for service on advisory boards. The other authors have no disclosures to declare. Publisher Copyright: © 2022, The Author(s).
PY - 2022/7
Y1 - 2022/7
N2 - Purpose: Peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE induces objective response in up to 57% of pancreatic neuroendocrine neoplasms (panNENs). Therefore, PRRT may comprise a downstaging option for panNEN patients who are not eligible for upfront curative surgery or are at high risk for recurrence. The aim of this study was to assess the potency of induction PRRT for locally advanced panNENs and to evaluate the effect of surgery after PRRT on overall survival (OS). Methods: Retrospective cohort study of panNEN patients treated with induction 177Lu-DOTATATE. Results: After PRRT, 26 out of 49 patients underwent pancreatic surgery with curative intent (PRRT + surgery). Partial objective response was obtained in 62% of the PRRT + surgery group versus 26% of the patients not undergoing panNEN surgery (PRRT-only group, p = 0.02). Downstaging in tumour-vessel interface was observed in 38% of all patients with at least one involved vessel. Median OS was 14.7 years (95% CI 5.9–23.6) for the PRRT + surgery group compared to 5.5 years (95% CI 4.5–6.5) for the PRRT-only group (p = 0.003). In the Cox proportional hazards analysis, surgery was not significantly associated with OS after propensity score adjustment with cumulative activity, performance status, tumour size after PRRT, and tumour grade. Median progression-free survival was 5.3 years (95% CI 2.4–8.1) for the PRRT + surgery group and 3.0 years (95% CI 1.6–4.4) for the PRRT-only group (p = 0.02). Conclusion: Early administration of PRRT followed by surgery is associated with favourable long-term outcomes in patients with locally advanced or oligometastatic panNEN and can be considered for selected patients with vascular involvement and/or increased risk of recurrence.
AB - Purpose: Peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE induces objective response in up to 57% of pancreatic neuroendocrine neoplasms (panNENs). Therefore, PRRT may comprise a downstaging option for panNEN patients who are not eligible for upfront curative surgery or are at high risk for recurrence. The aim of this study was to assess the potency of induction PRRT for locally advanced panNENs and to evaluate the effect of surgery after PRRT on overall survival (OS). Methods: Retrospective cohort study of panNEN patients treated with induction 177Lu-DOTATATE. Results: After PRRT, 26 out of 49 patients underwent pancreatic surgery with curative intent (PRRT + surgery). Partial objective response was obtained in 62% of the PRRT + surgery group versus 26% of the patients not undergoing panNEN surgery (PRRT-only group, p = 0.02). Downstaging in tumour-vessel interface was observed in 38% of all patients with at least one involved vessel. Median OS was 14.7 years (95% CI 5.9–23.6) for the PRRT + surgery group compared to 5.5 years (95% CI 4.5–6.5) for the PRRT-only group (p = 0.003). In the Cox proportional hazards analysis, surgery was not significantly associated with OS after propensity score adjustment with cumulative activity, performance status, tumour size after PRRT, and tumour grade. Median progression-free survival was 5.3 years (95% CI 2.4–8.1) for the PRRT + surgery group and 3.0 years (95% CI 1.6–4.4) for the PRRT-only group (p = 0.02). Conclusion: Early administration of PRRT followed by surgery is associated with favourable long-term outcomes in patients with locally advanced or oligometastatic panNEN and can be considered for selected patients with vascular involvement and/or increased risk of recurrence.
KW - Neuroendocrine
KW - Pancreas
KW - Peptide receptor radionuclide therapy
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85125404451&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00259-022-05734-8
DO - https://doi.org/10.1007/s00259-022-05734-8
M3 - Article
C2 - 35230492
SN - 1619-7070
VL - 49
SP - 3203
EP - 3214
JO - European journal of nuclear medicine and molecular imaging
JF - European journal of nuclear medicine and molecular imaging
IS - 9
ER -