Long-term results of PRRT in advanced bronchopulmonary carcinoid

Annapaola Mariniello, Lisa Bodei, Carmine Tinelli, S. Baio, Laura Gilardi, Marzia Colandrea, S. Papi, Giuseppe Valmadre, Nicola Fazio, Domenico Galetta, Giovanni Paganelli, Chiara Maria Grana

Research output: Contribution to journalArticle

Abstract

Purpose: Peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumours (NET) has been explored for almost two decades, but there are still few trials that have exclusively investigated well-differentiated and moderately differentiated NET arising from the respiratory tree. Thus, the aim of this study was to explore the outcome in patients affected by bronchopulmonary carcinoid (BPC) following PRRT. Methods: We retrospectively analysed 114 patients with advanced stage BPC consecutively treated with PRRT at the European Institute of Oncology, Milan, from 1997 to 2012 and followed until October 2014. The objective responses, overall survival (OS) and progression-free survival (PFS) were rated, and three different PRRT protocols (90Y-DOTATOC vs. 177Lu-DOTATATE vs. 90Y-DOTATOC + 177Lu-DOTATATE) were compared with regard to their efficacy and tolerability. Results: The median OS (evaluated in 94 of the 114 patients) was 58.8 months. The median PFS was 28.0 months. The 177Lu-DOTATATE protocol resulted in the highest 5-year OS (61.4 %). Morphological responses (partial responses + minor responses) were obtained in 26.5 % of the cohort and were associated with longer OS and PFS. The 90Y-DOTATOC + 177Lu-DOTATATE protocol provided the highest response rate (38.1 %). Adverse events were mild in the majority of patients. However, haematological toxicity negatively affected survival. No severe (grade 3/4) serum creatinine increase was observed. Patients treated with 90Y-DOTATOC alone more frequently showed a mild/moderate decrease in renal function. In patients treated with chemotherapy before PRRT had a shorter OS and PFS, and a higher risk of developing nephrotoxicity. Conclusion: In a large cohort of patients with advanced BPC treated in a “real-world” scenario and followed up for a median of 45.1 months (range 2 – 191 months), PRRT proved to be promising in prolonging survival and delaying disease progression. Despite the potential selection biases, considering the risk-benefit ratio, 177Lu-DOTATATE monotherapy seems the best option for PRRT. Our results indicate that the use of PRRT in earlier stages of the disease could provide a more favorable outcome.

Original languageEnglish
Pages (from-to)441-452
Number of pages12
JournalEuropean Journal of Pediatrics
Volume43
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

Fingerprint

Peptide Receptors
Carcinoid Tumor
Radioisotopes
Survival
Disease-Free Survival
Therapeutics
Neuroendocrine Tumors
Selection Bias
Disease Progression
Creatinine
Odds Ratio
(177lutetium-DOTA(O)Tyr3)octreotate
Kidney
Drug Therapy
DOTA-Tyr(3)-90Y-octreotide

Keywords

  • Bronchopulmonary carcinoid
  • Neuroendocrine tumours
  • Peptide receptor radionuclide therapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Long-term results of PRRT in advanced bronchopulmonary carcinoid. / Mariniello, Annapaola; Bodei, Lisa; Tinelli, Carmine; Baio, S.; Gilardi, Laura; Colandrea, Marzia; Papi, S.; Valmadre, Giuseppe; Fazio, Nicola; Galetta, Domenico; Paganelli, Giovanni; Grana, Chiara Maria.

In: European Journal of Pediatrics, Vol. 43, No. 3, 01.03.2016, p. 441-452.

Research output: Contribution to journalArticle

@article{01b13c08587847caa8b0fe11d3e7717a,
title = "Long-term results of PRRT in advanced bronchopulmonary carcinoid",
abstract = "Purpose: Peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumours (NET) has been explored for almost two decades, but there are still few trials that have exclusively investigated well-differentiated and moderately differentiated NET arising from the respiratory tree. Thus, the aim of this study was to explore the outcome in patients affected by bronchopulmonary carcinoid (BPC) following PRRT. Methods: We retrospectively analysed 114 patients with advanced stage BPC consecutively treated with PRRT at the European Institute of Oncology, Milan, from 1997 to 2012 and followed until October 2014. The objective responses, overall survival (OS) and progression-free survival (PFS) were rated, and three different PRRT protocols (90Y-DOTATOC vs. 177Lu-DOTATATE vs. 90Y-DOTATOC + 177Lu-DOTATATE) were compared with regard to their efficacy and tolerability. Results: The median OS (evaluated in 94 of the 114 patients) was 58.8 months. The median PFS was 28.0 months. The 177Lu-DOTATATE protocol resulted in the highest 5-year OS (61.4 {\%}). Morphological responses (partial responses + minor responses) were obtained in 26.5 {\%} of the cohort and were associated with longer OS and PFS. The 90Y-DOTATOC + 177Lu-DOTATATE protocol provided the highest response rate (38.1 {\%}). Adverse events were mild in the majority of patients. However, haematological toxicity negatively affected survival. No severe (grade 3/4) serum creatinine increase was observed. Patients treated with 90Y-DOTATOC alone more frequently showed a mild/moderate decrease in renal function. In patients treated with chemotherapy before PRRT had a shorter OS and PFS, and a higher risk of developing nephrotoxicity. Conclusion: In a large cohort of patients with advanced BPC treated in a “real-world” scenario and followed up for a median of 45.1 months (range 2 – 191 months), PRRT proved to be promising in prolonging survival and delaying disease progression. Despite the potential selection biases, considering the risk-benefit ratio, 177Lu-DOTATATE monotherapy seems the best option for PRRT. Our results indicate that the use of PRRT in earlier stages of the disease could provide a more favorable outcome.",
keywords = "Bronchopulmonary carcinoid, Neuroendocrine tumours, Peptide receptor radionuclide therapy",
author = "Annapaola Mariniello and Lisa Bodei and Carmine Tinelli and S. Baio and Laura Gilardi and Marzia Colandrea and S. Papi and Giuseppe Valmadre and Nicola Fazio and Domenico Galetta and Giovanni Paganelli and Grana, {Chiara Maria}",
year = "2016",
month = "3",
day = "1",
doi = "10.1007/s00259-015-3190-7",
language = "English",
volume = "43",
pages = "441--452",
journal = "European Journal of Pediatrics",
issn = "0340-6199",
publisher = "Springer Berlin Heidelberg",
number = "3",

}

TY - JOUR

T1 - Long-term results of PRRT in advanced bronchopulmonary carcinoid

AU - Mariniello, Annapaola

AU - Bodei, Lisa

AU - Tinelli, Carmine

AU - Baio, S.

AU - Gilardi, Laura

AU - Colandrea, Marzia

AU - Papi, S.

AU - Valmadre, Giuseppe

AU - Fazio, Nicola

AU - Galetta, Domenico

AU - Paganelli, Giovanni

AU - Grana, Chiara Maria

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Purpose: Peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumours (NET) has been explored for almost two decades, but there are still few trials that have exclusively investigated well-differentiated and moderately differentiated NET arising from the respiratory tree. Thus, the aim of this study was to explore the outcome in patients affected by bronchopulmonary carcinoid (BPC) following PRRT. Methods: We retrospectively analysed 114 patients with advanced stage BPC consecutively treated with PRRT at the European Institute of Oncology, Milan, from 1997 to 2012 and followed until October 2014. The objective responses, overall survival (OS) and progression-free survival (PFS) were rated, and three different PRRT protocols (90Y-DOTATOC vs. 177Lu-DOTATATE vs. 90Y-DOTATOC + 177Lu-DOTATATE) were compared with regard to their efficacy and tolerability. Results: The median OS (evaluated in 94 of the 114 patients) was 58.8 months. The median PFS was 28.0 months. The 177Lu-DOTATATE protocol resulted in the highest 5-year OS (61.4 %). Morphological responses (partial responses + minor responses) were obtained in 26.5 % of the cohort and were associated with longer OS and PFS. The 90Y-DOTATOC + 177Lu-DOTATATE protocol provided the highest response rate (38.1 %). Adverse events were mild in the majority of patients. However, haematological toxicity negatively affected survival. No severe (grade 3/4) serum creatinine increase was observed. Patients treated with 90Y-DOTATOC alone more frequently showed a mild/moderate decrease in renal function. In patients treated with chemotherapy before PRRT had a shorter OS and PFS, and a higher risk of developing nephrotoxicity. Conclusion: In a large cohort of patients with advanced BPC treated in a “real-world” scenario and followed up for a median of 45.1 months (range 2 – 191 months), PRRT proved to be promising in prolonging survival and delaying disease progression. Despite the potential selection biases, considering the risk-benefit ratio, 177Lu-DOTATATE monotherapy seems the best option for PRRT. Our results indicate that the use of PRRT in earlier stages of the disease could provide a more favorable outcome.

AB - Purpose: Peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumours (NET) has been explored for almost two decades, but there are still few trials that have exclusively investigated well-differentiated and moderately differentiated NET arising from the respiratory tree. Thus, the aim of this study was to explore the outcome in patients affected by bronchopulmonary carcinoid (BPC) following PRRT. Methods: We retrospectively analysed 114 patients with advanced stage BPC consecutively treated with PRRT at the European Institute of Oncology, Milan, from 1997 to 2012 and followed until October 2014. The objective responses, overall survival (OS) and progression-free survival (PFS) were rated, and three different PRRT protocols (90Y-DOTATOC vs. 177Lu-DOTATATE vs. 90Y-DOTATOC + 177Lu-DOTATATE) were compared with regard to their efficacy and tolerability. Results: The median OS (evaluated in 94 of the 114 patients) was 58.8 months. The median PFS was 28.0 months. The 177Lu-DOTATATE protocol resulted in the highest 5-year OS (61.4 %). Morphological responses (partial responses + minor responses) were obtained in 26.5 % of the cohort and were associated with longer OS and PFS. The 90Y-DOTATOC + 177Lu-DOTATATE protocol provided the highest response rate (38.1 %). Adverse events were mild in the majority of patients. However, haematological toxicity negatively affected survival. No severe (grade 3/4) serum creatinine increase was observed. Patients treated with 90Y-DOTATOC alone more frequently showed a mild/moderate decrease in renal function. In patients treated with chemotherapy before PRRT had a shorter OS and PFS, and a higher risk of developing nephrotoxicity. Conclusion: In a large cohort of patients with advanced BPC treated in a “real-world” scenario and followed up for a median of 45.1 months (range 2 – 191 months), PRRT proved to be promising in prolonging survival and delaying disease progression. Despite the potential selection biases, considering the risk-benefit ratio, 177Lu-DOTATATE monotherapy seems the best option for PRRT. Our results indicate that the use of PRRT in earlier stages of the disease could provide a more favorable outcome.

KW - Bronchopulmonary carcinoid

KW - Neuroendocrine tumours

KW - Peptide receptor radionuclide therapy

UR - http://www.scopus.com/inward/record.url?scp=84956702546&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84956702546&partnerID=8YFLogxK

U2 - 10.1007/s00259-015-3190-7

DO - 10.1007/s00259-015-3190-7

M3 - Article

VL - 43

SP - 441

EP - 452

JO - European Journal of Pediatrics

JF - European Journal of Pediatrics

SN - 0340-6199

IS - 3

ER -