title: Survival after somatostatin based radiopeptide therapy with (90)Y-DOTATOC vs. (90)Y-DOTATOC plus (177)Lu-DOTATOC in metastasized gastrinoma.
abstract: We aimed to explore the effects of (90)Y-DOTATOC and (90)Y-DOTATOC plus (177)Lu-DOTATOC on survival of patients with metastasized gastrinoma. Patients with progressive metastasized gastrinoma were treated with repeated cycles of (90)Y-DOTATOC or with cycles alternating between (90)Y-DOTATOC and (177)Lu-DOTATOC until tumor progression or permanent toxicity. Multivariable Cox regression analyses were used to study predictors of survival. A total of 36 patients were enrolled; 30 patients received (90)Y-DOTATOC (median activity per patient 11.8GBq; range: 6.1-62.2GBq) and 6 patients received (90)Y-DOTATOC plus (177)Lu-DOTATOC (median activity per patient: 14.8GBq; range: 7.4-14.8GBq). Response was found in 26 patients (72.2%), including morphological (n=12, 33.3%), biochemical (n=14, 38.9%) and/or clinical response (n=6, 16.2%). A total of 21 patients (58.3%) experienced hematotoxicity grade 1/2, while 1 patient (2.8%) experienced hematotoxicity grade 3; no grade 4 hematotoxicity occurred. Furthermore, 2 patients (5.6%) developed grade 4 renal toxicity; no grade 5 renal toxicity occurred. Responders had a significantly longer median survival from time of enrollment than non-responders (45.1 months, range: 37.1-53.1 months vs. 12.6 months, range: 11.0-14.2, hazard ratio: 0.12 (0.027-0.52), p=0.005). Additionally, there was a trend towards longer median survival with (90)Y-DOTATOC plus (177)Lu-DOTATOC as compared to (90)Y-DOTATOC alone (60.2 months, range: 19.8-100.6 months vs. 27.0 months, range: 4.0-50.0, hazard ratio: 0.21 (0.01-3.98), p=0.16). Response to (90)Y-DOTATOC and (90)Y-DOTATOC plus (177)Lu-DOTATOC therapy is associated with a longer survival in patients with metastasized gastrinoma. Both treatment regimens are promising tools for management of progressive gastrinoma.
authors.affiliation: Institute of Nuclear Medicine, University Hospital Basel CH ; Department of Radiology, David Geffen School of Medicine, UCLA Los Angeles, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Dumont
authors.affiliation: Institute of Nuclear Medicine, University Hospital Basel CH.
authors.forename: Daniela
authors.initials: D
authors.lastname: Seiler
authors.affiliation: Institute of Nuclear Medicine, University Hospital Basel CH ; Institute of Nuclear Medicine, University Hospital Bern CH.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Marincek
authors.affiliation: Institute of Nuclear Medicine, University Hospital Basel CH.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brunner
authors.affiliation: Institute of Nuclear Medicine, University Hospital Bern CH.
authors.forename: Piotr
authors.initials: P
authors.lastname: Radojewski
authors.affiliation: Division of Oncology, University Hospital Basel CH.
authors.forename: Christoph
authors.initials: C
authors.lastname: Rochlitz
authors.affiliation: Institute of Nuclear Medicine, University Hospital Basel CH.
authors.forename: Jan
authors.initials: J
authors.lastname: Müller-Brand
authors.affiliation: Division of Radiological Chemistry, University Hospital Basel CH.
authors.forename: Helmut R
authors.initials: HR
authors.lastname: Maecke
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel CH ; Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, CA.
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.affiliation: Institute of Nuclear Medicine, University Hospital Basel CH ; Institute of Nuclear Medicine, University Hospital Bern CH.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Walter
keywords: Yttrium; gastrinoma; lutetium; somatostatin; survival