Dataset Information

Liver-Directed Therapy for Neuroendocrine Tumor Metastases in the Era of Peptide Receptor Radionuclide Therapy.

ABSTRACT:

Opinion statement

The treatment of neuroendocrine neoplasm (NEN) liver metastases involves a multidisciplinary approach that includes liver-directed therapies (LDT) and systemic treatments, such as peptide receptor radionuclide therapy (PRRT). LDT has demonstrated efficacy in rapidly reducing tumor bulk, improving symptoms, and delaying disease progression. Interventional radiologists should be consulted prior to switching therapy for patients with progressive or symptomatic neuroendocrine tumor liver metastases. Long-term follow-up data on the safety of Yttrium-90 radioembolization before and after PRRT remain limited. Therefore, a more conservative approach may be to preferentially employ transarterial embolization (TAE) or transarterial chemoembolization (TACE) for patients' somatostatin receptor-avid disease who may be future candidates for PRRT. Notable exceptions where radioembolization may be a preferred treatment strategy may be patients with history of biliary tract instrumentation, asymmetric unilobar disease distribution, and rapidly progressive diffuse liver involvement. Selection of local treatment modality, sequencing, and combination of LDT with systemic therapy require further investigation.

SUBMITTER: Rabei R

PROVIDER: S-EPMC10781814 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Liver-Directed Therapy for Neuroendocrine Tumor Metastases in the Era of Peptide Receptor Radionuclide Therapy.

Rabei Rana R Fidelman Nicholas N

Current treatment options in oncology 20231215 12

<h4>Opinion statement</h4>The treatment of neuroendocrine neoplasm (NEN) liver metastases involves a multidisciplinary approach that includes liver-directed therapies (LDT) and systemic treatments, such as peptide receptor radionuclide therapy (PRRT). LDT has demonstrated efficacy in rapidly reducing tumor bulk, improving symptoms, and delaying disease progression. Interventional radiologists should be consulted prior to switching therapy for patients with progressive or symptomatic neuroendocri ...[more]

PMID: 38100020

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Project description:BackgroundPeptide receptor radionuclide therapy (PRRT) is effective for treating midgut neuroendocrine tumors (NETs); however, incorporation of PRRT into routine practice in the U.S. is not well studied. Herein we analyze the first year of PRRT implementation to determine tolerance of PRRT and factors that increase risk of PRRT discontinuation.Materials and methodsMedical records were reviewed and data were abstracted on all patients with NETs scheduled for PRRT during the first year of PRRT implementation at a U.S. NET referral center (August 2018 through July 2019). Logistic regression was used to identify factors associated with PRRT discontinuation.ResultsFifty-five patients (56% male) were scheduled for PRRT over the study period. The most common primary NET location was small bowel (47%), followed by pancreas (26%), and 84% of the NETs were World Health Organization grade 1 or 2. The cohort was heavily pretreated with somatostatin analog (SSA) therapy (98%), non-SSA systemic therapy (64%), primary tumor resection (73%), and liver-directed therapy (55%). At the time of analysis, 52 patients completed at least one PRRT treatment. Toxicities including bone marrow suppression and liver function test (LFT) abnormalities were comparable to prior publications. Eleven patients (21%) prematurely discontinued PRRT because of toxicity or an adverse event. Pretreatment LFT abnormality was associated with increased risk of PRRT cancellation (odds ratio: 12; 95% confidence interval: 2.59-55.54; p < .001).ConclusionPRRT can be administered to a diverse NET population at a U.S. NET referral center. Baseline liver function test abnormality increases the likelihood of PRRT discontinuation.Implications for practicePeptide receptor radionuclide therapy (PRRT) can be successfully implemented at a U.S. neuroendocrine tumor (NET) referral center in a NET population that is diverse in tumor location, grade, and prior treatment history. Toxicity and adverse effects of PRRT are comparable to prior reports; however, 21% of individuals prematurely discontinued PRRT. Patients with baseline liver function test abnormalities were more likely to discontinue PRRT than patients with normal liver function tests, which should be taken into consideration when selecting treatment options for NETs.

Project description:IntroductionClinical experiences of peptide receptor radionuclide therapy (PRRT) in patients with adrenocorticotropic hormone (ACTH) producing neuroendocrine tumor (NET) were extremely rare.Case presentationA 60-year-old woman with hypertension, lower-extremity edema, hypoalbuminemia, hypokalemia, and multiple hepatic tumors was hospitalized for further examination and treatment. Endocrine testing detected excessive levels of ACTH and cortisol in her blood. Pathohistological examination revealed the hepatic lesions to be ACTH-positive grade 2 NETs (G2). A diagnosis of ectopic ACTH-producing NET was made. The patient was initially treated with the 11-hydroxylase inhibitor, metyrapone, to control hypercortisolemia and the long-acting somatostatin analog, lanreotide. Simultaneously, everolimus was continued for about 1 year. Subsequently, hepatic tumors were surgically resected, leading to successful and rapid normalization of ACTH secretion and resolution of hypercortisolemia. However, the disease relapsed and presented with multiple hepatic masses and increased ACTH 18 months after surgery. As sunitinib and subsequent streptozocin chemotherapy failed to control the disease, PRRT with 177Lu-DOTATATE was performed. ACTH levels increased after initiation of PRRT, and clinical manifestations, such as pigmentation, hypertension, and hyperglycemia, were remarkable. The patient was treated with antihypertensive and antidiabetic agents, and required an increased dose of metyrapone and addition of the cortisol biosynthesis inhibitor, osilodrostat. After four cycles of PRRT, the hepatic tumors showed a remarkable reduction in size with normalization of ACTH level and withdrawal of cortisol synthesis inhibitors.ConclusionAlthough PRRT was effective, we should consider the occurrence of hormonal crisis during the therapy. Due to the rarity and complexity of hormone-producing tumors, cooperation between medical oncologists and endocrinologists is important for patient management.

Dataset Information

Liver-Directed Therapy for Neuroendocrine Tumor Metastases in the Era of Peptide Receptor Radionuclide Therapy.

Opinion statement

Publications

Liver-Directed Therapy for Neuroendocrine Tumor Metastases in the Era of Peptide Receptor Radionuclide Therapy.

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