Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours

Abstract

// Lisi Elizabeth Lim 1 , David L. Chan 2 , 3 , David Thomas 4 , Yang Du 5 , Gary Tincknell 4 , Anna Kuchel 6 , 7 , Alexander Davis 2 , Dale L. Bailey 2 , 8 , Nick Pavlakis 2 , 8 , 9 , Gabrielle Cehic 5 , 10 , William Macdonald 11 , David Wyld 6 , 7 and Eva Segelov 1 , 12 1 Department of Medical Oncology, Monash Health, Melbourne, Australia 2 Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia 3 Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, Australia 4 Department of Medical Oncology, St. George Hospital, Sydney, Australia 5 Department of Nuclear Medicine, The Queen Elizabeth Hospital, Adelaide, Australia 6 Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia 7 Faculty of Medicine, University of Queensland, Brisbane, Australia 8 Sydney Vital Translational Cancer Research Centre, Royal North Shore Hospital, Sydney, Australia 9 Faculty of Medicine and Health, University of Sydney, Sydney, Australia 10 University of South Australia, Adelaide, Australia 11 Department of Nuclear Medicine, Fiona Stanley Hospital, Perth, Australia 12 Faculty of Medicine, Monash University, Melbourne, Australia Correspondence to: Lisi Elizabeth Lim, email: [email protected] Keywords: lung; carcinoid; atypical; neuroendocrine; peptide receptor radionuclide therapy Received: May 09, 2020     Accepted: June 15, 2020     Published: July 07, 2020 ABSTRACT Background: Peptide receptor radionuclide therapy (PRRT) is an approved treatment modality for gastroenteropancreatic neuroendocrine tumours (GEP NETs), Although Phase III randomised clinical trial data is not available for NETs of other site of origin, in practice, PRRT is used more widely in clinical practice, based on its mechanism of targeting the somatostatin receptor. Use of PRRT for lung (bronchial) NET, specifically typical and atypical carcinoid (TC, AC), has been reported only in small retrospective case series. This multicentre study adds to the evidence regarding utility of PRRT for lung NETs. Materials and Methods: A retrospective chart review of patients with TC and AC who received 177 Lu-dotatate PRRT between January 2002 and June 2019 in six hospitals across Australia was undertaken. Data regarding demographics, efficacy and toxicity was evaluated at each site by the treating clinician. Results: Forty-eight patients (32 AC, 15 TC, 1 unclassified) received a median of four 177 Lu-dotatate treatments. There was a median of one prior line of systemic treatment (range: 0–3). The response rate to 177 Lu-dotatate was 33%, with a median overall survival of 49 months (range of 3–91), at a median follow up of 33 months. This compares favourably with GEP NET. Overall toxicity was recorded as modest. Conclusions: 177 Lu-dotatate PRRT in patients with lung NETs is used in real world practice, where it appears well-tolerated with some efficacy. Further evidence could be obtained through a global prospective clinical or registry trial.

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