417P Availability and Utility of Functional Imaging (FI) and Peptide Receptor Radionuclide Therapy (PRRT) in the CommNETS Collaboration (Australia, Canada and New Zealand)

Abstract

Background The use of FI and PRRT is integral to the management of neuroendocrine tumors (NETs). Considerable global variability exists in access to and utility of FI and PRRT. Methods A survey of PRRT centres within CommNETS was conducted to explore the use of FI and PRRT. Two companion surveys were completed by the lead in nuclear medicine and medical oncology per site. Descriptive and inferential statistical methods including nonparametric analyses were performed to evaluate differences in accessibility and availability, models of care, protocols and funding. Results 16 surveys were sent to the 8 PRRT centres across CommNETS (Aust: 6, Canada: 2, NZ: 0). Response rate was 100%. All were academic centres reviewing 110 new and 140 followup patients per month. All centres had access to Octreotide scans, but in Australia this has been superseded by tandem Gallium68 (Ga) and 18Fluorine (FDG) positron emission tomography (PET) scans to stage and assess biology and heterogeneity of NETs. GaPET scans were not available in Canada. Although FDGPET was unfunded for NETs within CommNETS, it was routinely ordered (63%) for grade 2 or 3 NETs. To assess response, 63% used GaPET scans at 6month intervals and 38% ordered both Ga and FDGPET scans. PRRT was only available on clinical trial in Canada. Lutetium177 was the standard PRRT isotope at all centres for most indications. Radiosensitising chemotherapy was used in 5 centres (not in Canada) capecitabine (45%) or capecitabine and temozolomide (36%). Four cycles of PRRT was universal but intervals varied between every 8 weeks (50%), 6 weeks (25%) or 10 weeks (25%), usually without maintenance therapy (63%). Considerable variation existed regarding concurrent somatostatin analogue usage, determination of renal function, dosimetry, dose adjustments and minimum haematological parameters. Only five sites recorded quality of life outcomes. Conclusions This is the first survey to assess the availability and utility of FI and PRRT within CommNETS. Future collaborative efforts will try to improve access and share knowledge between experienced and upcoming PRRT centres to develop standard operating procedures and cooperative trials. Legal entity responsible for the study CommNETs Collaboration Funding CommNETs Collaboration Disclosure All authors have declared no conflicts of interest.