title: Radiolabeled somatostatin analog [177Lu-DOTA0,Tyr3]octreotate in patients with endocrine gastroenteropancreatic tumors.
abstract: OBJECTIVE
  There are few treatment options for patients with metastasized or inoperable endocrine gastroenteropancreatic (GEP) tumors. Chemotherapy can be effective, but the response is usually less than 1 year. Here, we present the results of treatment with a radiolabeled somatostatin analog, [177Lu-DOTA0,Tyr3]octreotate (177Lu-octreotate).
  
  
  METHODS
  One hundred thirty-one patients with somatostatin receptor-positive tumors were treated with up to a cumulative dose of 600 to 800 mCi (22.2 to 29.6 GBq) of 177Lu-octreotate.
  
  
  RESULTS
  One patient developed renal insufficiency, and another patient developed hepatorenal syndrome. Creatinine clearance did not change significantly in the other patients. WHO hematologic toxicity grade 3 or 4 occurred after less than 2% of the administrations. We observed complete remission in three patients (2%), partial remission in 32 patients (26%), minor response (tumor diameter decrease of 25% to 50%) in 24 patients (19%), stable disease (SD) in 44 patients (35%), and progressive disease (PD) in 22 patients (18%). Higher remission rates were positively correlated with high uptake on pretherapy somatostatin receptor imaging and a limited number of liver metastases, whereas PD was significantly more frequent in patients with a low performance score and extensive disease. Median time to progression in 103 patients who either had SD or tumor regression was more than 36 months.
  
  
  CONCLUSIONS
  Treatment with 177Lu-octreotate results in tumor remission in a high percentage of patients with GEP tumors. Serious side effects are rare. The median time to progression compares favorably with chemotherapy. Results are better in patients with a limited tumor load. Therefore, early treatment, even in patients who have no PD, may be better.
authors.affiliation: Department of Nuclear Medicine, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands. d.j.kwekkeboom@erasmusmc.nl
authors.forename: Dik J
authors.initials: DJ
authors.lastname: Kwekkeboom
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Teunissen
authors.forename: Willem H
authors.initials: WH
authors.lastname: Bakker
authors.forename: Peter P
authors.initials: PP
authors.lastname: Kooij
authors.forename: Wouter W
authors.initials: WW
authors.lastname: de Herder
authors.forename: Richard A
authors.initials: RA
authors.lastname: Feelders
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
authors.forename: Jan-Paul
authors.initials: JP
authors.lastname: Esser
authors.forename: Boen L
authors.initials: BL
authors.lastname: Kam
authors.forename: Eric P
authors.initials: EP
authors.lastname: Krenning
mesh_terms: D007516:Adenoma, Islet Cell / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D004701:Endocrine Gland Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000031:analogs & derivatives; D009942:Organometallic Compounds / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017481:Receptors, Somatostatin; D016896:Treatment Outcome
chemical_list: D009942:Organometallic Compounds; D017481:Receptors, Somatostatin; C447941:lutetium Lu 177 dotatate; D015282:Octreotide