Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2020; 26(13): 1513-1524
Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1513
Evaluation of 177Lu-Dotatate treatment in patients with metastatic neuroendocrine tumors and prognostic factors
Estephany Abou Jokh Casas, Virginia Pubul Núñez, Urbano Anido-Herranz, María del Carmen Mallón Araujo, Maria del Carmen Pombo Pasín, Miguel Garrido Pumar, José Manuel Cabezas Agrícola, José Manuel Cameselle-Teijeiro, Ashraf Hilal, Álvaro Ruibal Morell
Estephany Abou Jokh Casas, Virginia Pubul Núñez, María del Carmen Mallón Araujo, Maria del Carmen Pombo Pasín, Miguel Garrido Pumar, Álvaro Ruibal Morell, Department of Nuclear Medicine, Santiago de Compostela´s University Hospital, Santiago de Compostela 15706, A Coruña, Spain
Urbano Anido-Herranz, Department of Oncology, Santiago de Compostela´s University Hospital, Santiago de Compostela 15706, A Coruña, Spain
José Manuel Cabezas Agrícola, Department of Endocrinology, Santiago de Compostela´s University Hospital, Santiago de Compostela, 15706, A Coruña, Spain
José Manuel Cameselle-Teijeiro, Department of Pathology, Santiago de Compostela´s University Hospital, Santiago de Compostela 15706, A Coruña, Spain
Ashraf Hilal, Department of Statistics, University of Santiago de Compostela, Santiago de Compostela 15706, A Coruña, Spain
Author contributions: Abou Jokh Casas E, Pubul Núñez V, del Carmen Mallón Araujo M and del Carmen Pombo Pasín M designed the research and wrote the paper; Anido-Herranz U, Hilal A and Garrido Pumar M contributed new reagents/analytic tools; Cabezas Agrícola JM, Cameselle-Teijeiro JM and Ruibal Morell Á analyzed the data.
Institutional review board statement: The study was reviewed and approved by the ethics committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Estephany Abou Jokh Casas, MD, Occupational Physician, Department of Nuclear Medicine, Santiago de Compostela´s University Hospital, Avenida Choupana, Santiago de Compostela 15706, A Coruña, Spain. estephanyaboujokh@gmail.com
Received: December 8, 2019
Peer-review started: December 8, 2019
First decision: January 9, 2020
Revised: March 6, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: April 7, 2020
Processing time: 120 Days and 22.4 Hours
ARTICLE HIGHLIGHTS
Research background

The incidence and prevalence of neuroendocrine tumors are currently increasing, probably due to the extensive use of more developed routine radiological tests and endoscopic techniques. In patients with limited cytoreductive options, peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogues 177Lu-DOTA0-Tyr3-octreotate (177Lu-Dotatate) has been used successfully in patients diagnosed with metastatic gastroenteropancreatic somatostatin receptor positive tumors in the past two decades.

Research motivation

The aim of this study was to determine the impact of this treatment on patient’s quality of life, radiological and metabolic response, overall survival, prognostic factors and its toxicity.

Research objectives

The determination of prognostic factors that can modify the overall survival of these patients is of vital importance because it could allow a more specialized therapy and increase patient’s surveillance when required. This might be an interesting approach in future research.

Research methods

This is a retrospective longitudinal observational study in which impact on quality of life, radiological and metabolic response, overall survival, prognostic factors and toxicity were evaluated in patients diagnosed with advanced tumors expressing somatostatin receptors treated with PRRT. The information pertinent to this cohort of patients was collected through the clinical history, obtaining information about clinical data, treatment response and disease state. These data were treated confidentially and in an encrypted form for analysis. Written consent was obtained from all patients.

Research results

In this cohort of patients, overall survival was inversely proportional with respect to toxicity in previous treatments (P < 0.05), tumor grade and the presence of bone lesions and was directly proportional to matching lesion findings between Octreoscan and computed tomography (CT) pre-PRRT (P < 0.01) andsurgery of the primary tumor or its metastasis. Also, we found that pseudo-progression is a common finding observed in the first stages of the treatment that should be taken into consideration by clinicians in daily practice. We consider that the matching lesions in CT and Octreoscan® before PRRT treatment could be a prognostic factor and should be studied with a greater cohort of patients. If corroborated, this finding could be considered in treatment decisions and may result in major patient surveillance.

Research conclusions

Overall survival was inversely proportional with respect to toxicity in previous treatments (P < 0.05) and was directly proportional to matching lesion findings between Octreoscan and CT pre-PRRT. Matching lesion findings between Octreoscan and CT pre-PRRT should be taken into consideration when treating these patients.

Research perspectives

This study reveals that prognostic factors should be taken into consideration because they modify the overall survival. Therefore, future research should focus on finding new prognostic factors that could allow specialized patient surveillance. In future studies, a larger number of patients should be included to extract more conclusive results that would allow the identification of new prognostic factors.