Lessons from a multicentre retrospective study of peptide receptor radionuclide therapy combined with lanreotide for neuroendocrine tumours: a need for standardised practice

Vikas Prasad, Raj Srirajaskanthan, Christos Toumpanakis, Chiara Maria Grana, Sergio Baldari, Tahir Shah, Angela Lamarca, Frédéric Courbon, Klemens Scheidhauer, Eric Baudin, Xuan Mai Truong Thanh, Aude Houchard, Clarisse Dromain, Lisa Bodei

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: PRELUDE aimed to assess use and effectiveness/safety of lanreotide autogel/depot (LAN) combined with 177Lu-DOTATOC or 177Lu-DOTATATE (LAN–peptide receptor radionuclide therapy [PRRT]) in patients with progressive neuroendocrine tumours (NETs). Methods: International, non-interventional, retrospective, non-comparative analysis of medical records from patients with progressive metastatic or locally advanced grade 1 or 2 gastroenteropancreatic (GEP)- or lung-NETs. The primary endpoint was progression-free survival (PFS) at end of last LAN–PRRT cycle. Secondary endpoints included PFS at last available follow-up, best overall response, objective response rate (ORR), presence and severity of diarrhoea and flushing, and safety. Post-hoc analyses were conducted to determine pre-treatment tumour growth rate (TGR) cutoffs that best predicted the ORR during treatment. Results: Forty patients were enrolled (GEP-NETs, n = 39; lung-NETs, n = 1). PFS rates were 91.7% at end of last LAN–PRRT cycle and 95.0% at last available follow-up. In the full analysis set, best overall response among patients with GEP-NETs (n = 23) was stable disease (n = 14, 60.9%), partial response (n = 8, 34.8%) and progressive disease (n = 1, 4.3%). The ORR was 27.3% at end of last LAN–PRRT cycle and 36.8% at last available follow-up. Optimal baseline TGR cutoffs for predicting ORR at these time points were 1.18% and 0.33%, respectively. At baseline, 81.0% of patients had diarrhoea or flushing; both remained stable or improved in most cases. No increased adverse drug reactions were reported. Conclusion: Despite the major recruitment shortfall for the PRELUDE study, effectiveness data were encouraging in this selected population, highlighting the potential usefulness and feasibility of LAN combined with and after PRRT in patients with GEP-NETs. The study also identified challenges associated with evaluating clinical practice in a rare-disease setting and highlighted the need for standardisation of PRRT procedures. Trial registration: Trial number: NCT02788578; URL: https://clinicaltrials.gov/ct2/show/NCT02788578

Original languageEnglish
Pages (from-to)2358-2371
Number of pages14
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume47
Issue number10
DOIs
Publication statusPublished - Sep 1 2020

Keywords

  • Lu-DOTATATE
  • Lu-DOTATOC
  • Lanreotide
  • Neuroendocrine tumours
  • Peptide receptor radionuclide therapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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