In-111 Pentetreotide Research Articles

SAT-LB060 Clinical Presentation and Management of Primary Ovarian Carcinoids in Multiple Endocrine Neoplasia Type 1

Introduction MEN1 is an autosomal dominant condition characterized by parathyroid, anterior pituitary and enteropancreatic endocrine cell tumors. Carcinoids occur in 5-15% patients, majority of which are of foregut origin (thymus, bronchus, stomach and duodenum). Only 1 case of ovarian carcinoid has been reported in association with MEN1, and was not confirmed with genetic testing. Case report A 33-year-old female with a macroprolactinoma and primary hyperparathyroidism was referred to us with a presumptive diagnosis of MEN1. Genetic testing showed a heterozygous germline mutation in the MEN1 gene, c.219_220delCG (frameshift leading to premature protein truncation). She had no family history consistent with MEN1. EGD showed two submucosal nodules in the duodenum with confirmed histology of gastrinomas. CT demonstrated 8.7 x 7.7 cm right adnexal mass containing foci of soft tissue density and calcification. Laparoscopic resection was attempted but the mass was too large to be delivered en-bloc. Operative approach was changed to a minilaparotomy and the mass was delivered in a piecemeal fashion. Pathology demonstrated a benign dermoid cyst with neuroendocrine tumor consistent with carcinoid extending into peri-ovarian tissues. 4 years later, she presented with a lower abdominal palpable mass. CT showed an irregular, avidly enhancing 11.7 x 8.7 cm pelvic mass, extending through the anterior abdominal wall into the subcutaneous fat with satellite lesions within the anterior subcutaneous abdomen. The CT abnormalities corresponded to abnormally elevated In-111 pentetreotide uptake. Biopsy of one of the subcutaneous lesions showed metastatic neuroendocrine neoplasm with Ki67 index of 2%. Targeted genetic analysis for the patient’s MEN1 mutation using DNA samples isolated from the primary adnexal mass as well as the recurrent abdominal wall tumor demonstrated predominantly mutant sequence in both specimens, confirming LOH at the MEN1 gene locus. 5 months later, the patient presented with obstructive uropathy from nodal metastases. She underwent debulking surgery via exploratory laparotomy, panniculectomy, resection of metastatic abdominal wall tumors and abdominal wall reconstruction. Post operatively, FDG-PET scan showed few scattered disease foci. She was commenced on monthly octreotide injections. Conclusions This case represents to our knowledge, the first genetically confirmed case of ovarian carcinoid arising by a MEN1 mechanism. Ovarian carcinoid should be considered as a differential in MEN1 patients with adnexal mass. Extreme caution should be exercised during surgical resection, as failure to remove an ovarian carcinoid en masse can result in peritoneal seeding and recurrence. For patients with advanced disease, systemic therapy options include somatostatin receptor analogs, peptide receptor radioligand therapy, and novel agents targeting mTOR and VEGF. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Impact of initial imaging with gallium-68 dotatate PET/CT on diagnosis and management of patients with neuroendocrine tumors (NETs): A sequential case series.

379 Background: Somatostatin analogue functional imaging with Ga-68 Dotatate PET/CT has demonstrated superiority in lesion detection in patients with NETs. The effect of this novel imaging modality on US clinical practice and its usefulness in different types of NETs is not well described. We describe the impact of initial NETSPOT imaging on diagnosis and management in NET patients at a large urban medical center. Methods: Consecutive patients diagnosed with NETs and referred to our institution who received an initial Ga-68 Dotatate PET/CT between 07/2017-09/2018 were included. Imaging was reviewed and compared to prior available CT, MRI, and/or In-111 Pentetreotide scans. Results: Among 101 patients, 51/50 were female/male, tumor origins were gastroenteropancreatic (GEP) (75%), Unknown Primary (UP) (13%), lung (8%), thymic (2%), and other (2%). All tumors were histologically well/moderately differentiated and 37/51/3/10 were G1/G2/G3/Unknown, respectively. Initial imaging with Ga-68 Dotatate PET/CT revealed additional metastatic disease in 37 of 77(48%) patients with prior evidence of metastatic disease. Most common sites were distant lymph nodes (18), bone (15) and liver (9), peritoneal/pleural (4). A previously UP tumor was identified in 3 patients. No patients with metastatic lung carcinoids (6 atypical, 2 typical) or thymic NETs (2 atypical/G2) NETs had evidence of Ga-68 Dota PET/CT uptake above reference liver SUV levels. Results of imaging altered patient management as follows: 14 initiated systemic therapy due to documentation of progression, in 6 surgical therapy was altered, in 4 biopsy/other management was changed. In 11 patients with no tumor Ga-68 Dotatate uptake, decisions about use of PRRT and somatostatin analogues was altered. Conclusions: In this series, Ga-68 Dotatate PET/CT altered diagnosis and management in 35/101 NET patients. Among GEP and UP NETs, Dotatate imaging diagnosed primarily new nodal, bone, liver and pleural/peritoneal metastases missed by other imaging modalities. Results support the routine use of Ga-68 Dotatate PET/CT in the care of patients with advanced and early stage NETS.

Management of Gastrointestinal Neuroendocrine Tumors.

Neuroendocrine neoplasms (NENs) are derived from neuroendocrine cell system and can have benign or malignant characteristics. They are rare tumors, but have been increasing in incidence over the past 40 years. Patients with NENs may develop symptoms due to primary tumor invasion, metastasis, or from secretion of hormonally active tumor substances. Multiple imaging modalities are used for diagnosis and staging, including specialty scans such as 111In pentetreotide (Octreoscan) and 68Gallium-DOTATATE, along with endoscopy, endoscopic ultrasound, and biochemical marker testing. Treatment involves both surgical approach, for both primary and metastatic lesions, as well as medical management for symptom management and disease progression. This article will review the current clinical knowledge regarding the diagnosis, treatment, and prognosis of these fascinating neoplasms and the associated hormonal syndromes.

Somatostatin receptor expression in non-classical locations - clinical relevance?

In-111 pentetreotide (Octreoscan) is a radiolabeled somatostatin analog with high binding affinity to somatostatin receptors (SSTR) used in somatostatin receptor scintigraphy (SRS). Pentetreotide labelled with In-111 is widely used due to its high affinity to SSTR 2 and 5. SSTR are expressed on neuroendocrine cells as well as several non-neural and non-endocrine cells with varying levels of density. We retrospectively reviewed articles and publications related to octreoscan accumulation in sites that classically do not have high concentrations of SSTR as well as in organs and tissues from diseases which are not usually diagnosed by octreoscan. The significance of a positive uptake as assessed by octreoscan in non-somatostatin receptor related diseases is not fully understood yet. Localization of octreotide in non-oncological disease states such as inflammation is due to presence of SSTR in activated immunological cells, over-expression by activated cells in the respective tissue and SSTR expression by blood vessels. In granulomatous diseases, over-expression of SSTR2 preferential binding sites were detected in epitheloid and giant cells. The purpose of the current study is to identify octreoscan localization in non-somatostatin receptor related disease sites to better understand the mechanism of this nonspecific accumulation which may help expand the clinical utilization of functional imaging utilizing somatostatin receptor scintigraphy in diagnosis and perhaps therapy.

Diffuse Pancreatic Neuroendocrine Tumor: A Rare Presentation.

Diffuse involvement of the pancreas in neuroendocrine tumor is a rare presentation, and its appearance on In-111 pentetreotide scan has not been reported earlier in the literature. We present the whole body images from In-111 pentetreotide scan, contrast-enhanced computed tomography images, and histopathology correlation.

Appropriate Use Criteria for Somatostatin Receptor PET Imaging in Neuroendocrine Tumors.

Somatostatin receptor positron emission tomography (SSTR-PET) is an imaging modality for patients with neuroendocrine tumors (NETs) that has demonstrated a significant improvement over conventional imaging (CI). SSTR-PET should replace In-111 pentetreotide scintigraphy (OctreoScan) in all indications in which SSTR scintigraphy is currently being used. These appropriate use criteria (AUC) are intended to aid referring medical practitioners in the appropriate use of SSTR-PET for imaging of patients with NETs, and the indications were evaluated in well-differentiated NETs. Of the 12 clinical scenarios evaluated, nine were graded as appropriate: initial staging after the histologic diagnosis of NET, evaluation of an unknown primary, evaluation of a mass suggestive of NET not amenable to endoscopic or percutaneous biopsy, staging of NET prior to planned surgery, monitoring of NET seen predominantly on SSTR-PET, evaluation of patients with biochemical evidence and symptoms of a NET, evaluation of patients with biochemical evidence of a NET without evidence on CI or a prior histologic diagnosis, restaging at time of clinical or laboratory progression without progression on CI, and new indeterminate lesion on CI with unclear progression. Representatives from the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the American College of Radiology (ACR), the American Society of Clinical Oncology (ASCO), the North American Neuroendocrine Tumor Society (NANETS), the European Association of Nuclear Medicine (EANM), the Endocrine Society, the Society of Surgical Oncology, the National Comprehensive Cancer Network (NCCN), the American College of Physicians (ACP), the American Gastroenterological Association (AGA), and the World Conference on Interventional Oncology (WCIO) assembled under the auspices of an autonomous workgroup to develop the following AUC.

SPECT/CT in neuroendocrine tumours

Neuroendocrine tumours (NETs) are a heterogeneous group of neoplasms with very varying clinical expressions. Nuclear medicine plays an important role in the imaging and treatment of these tumours. Despite the advent of several PET radiopharmaceuticals, SPECT imaging with the labelled somatostatin receptor analogue In-111 pentetreotide or with radioiodinated MIBG is still a very useful technique for evaluating patients with NETs. The aim of this review is to summarise the applications, in the study of NETs, of hybrid SPECT/CT imaging performed using these gamma-emitting radiopharmaceuticals. The combined use of SPECT and CT in hybrid devices is of value when applied to scintigraphic procedures in NETs: the addition of anatomical maps provides a precise localisation of SPECT findings and allows the exclusion of disease in sites of physiological tracer uptake. These advantages translate into better sensitivity and specificity, both of which are essential for the diagnosis and accurate staging of NETs. SPECT/CT hybrid images are able to provide additional information that improves the diagnostic accuracy and confidence of SPECT interpretation and leads to changes in therapeutic options in about 25 % of patients. Therefore, SPECT/CT should be routinely performed and considered standard practice in the diagnostic work-up and treatment planning of patients with NETs submitted to In-111 pentetreotide or radioiodinated MIBG imaging. This approach can still be used as an alternative to PET/CT options when the latter are not available.

Improved Benefit of SPECT/CT Compared to SPECT Alone for the Accurate Localization of Endocrine and Neuroendocrine Tumors

Objective: To assess the clinical utility of SPECT/ CT in subjects with endocrine and neuroendocrine tumors compared to SPECT alone.Material and Methods: 48 subjects (31 women;17 men; mean age 54±11) with clinical suspicion or diagnosis of endocrine and neuroendocrine tumor had 50 SPECT/CT scans (32 Tc-99m MIBI, 5 post treatment I-131, 8 In-111 Pentetreotide, and 5 I-123 MIBG). SPECT alone findings were compared to SPECT/CT and to pathology or radiological follow up.Results: From the 32 Tc-99m MIBI scans, SPECT accurately localized the lesion in 22 positive subjects while SPECT/CT did in 31 subjects. Parathyroid lesions not seen on SPECT alone were smaller than 10 mm. In five post treatment I-131 scans, SPECT alone neither characterized, nor localized any lesions accurately. SPECT/CT revealed 3 benign etiologies, a metastatic lymph node, and one equivocal lesion. In 8 In-111 Pentetreotide scans, SPECT alone could not localize primary or metastatic lesions in 6 subjects all of which were localized with SPECT/CT. In five I-123 MIBG scans, SPECT alone could not detect a 1.1 cm adrenal lesion or correctly characterize normal physiologic adrenal uptake in consecutive scans of the same patient with prior history of adrenelectomy, all of which were correctly localized and characterized with SPECT/CT.Conclusion: SPECT/CT is superior to SPECT alone in the assessment of endocrine and neuroendocrine tumors. It is better in lesion localization and lesion characterization leading to a decrease in the number of equivocal findings. SPECT/CT should be included in the clinical work up of all patients with diagnosis or suspicion of endocrine and neuroendocrine tumors.Conflict of interest:None declared.

Increased Mammary Uptake on 111In Pentetreotide Scintigraphy

The normal scintigraphic features of 111In pentetreotide include uptake in the pituitary, thyroid, liver, spleen, kidneys, urinary bladder, gallbladder, and bowel. In premenopausal women, faint activity can be seen in the breasts. We present 2 cases of symmetrical, markedly increased mammary uptake. Our hypothesis to explain this pattern of uptake is an upregulation of the somatostatin type 2 receptor caused by high blood levels of estradiol during pregnancy. Estradiol levels during the menstrual cycle could therefore explain the variable degree of uptake commonly seen in premenopausal women.

Comparison of 18F-FDG PET/CT and 111In Pentetreotide Scan for Detection of Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm with propensity for nodal metastases. A few reports have presented imaging results with FDG PET/CT or 111In-pentetreotide (OctreoScan, OCT) indicating a higher sensitivity for FDG than OCT, but no reports have directly compared FDG to OCT in the same patients. We reviewed our experience in a limited number of patients who underwent both procedures. Patients with MCC who had FDG PET and OCT between 2000 and 2010 in our center were retrospectively reviewed. Patients were included if they had FDG PET/CT and OCT scan within a 2-month interval. For each eligible patient, we compared all abnormal lesions identified on either scan. The findings were verified by pathology or other imaging techniques up to a 4-month follow-up. A total of 9 patients met the selection criteria with 10 dual scans (1 was scanned twice). Three patients had no documented sites of disease at the time of imaging. One patient had negative findings on both FDG and OCT initially, but 1 year later developed FDG-positive OCT-negative disease. Five patients had metastatic disease at the time of imaging: 2 were negative on OCT and positive on FDG; the other 3 were positive on both scans but had more lesions on FDG. Our data on a small number of patients are in agreement with prior individual FDG or OCT reports and suggest that, overall, FDG PET/CT detects more MCC lesions and upgrades MCC stage compared with the OCT scan. Importantly, there were no lesions identified by OCT that were missed by PET. Thus, given the added resolution and sensitivity of PET, the use of OCT in MCC in the modern era is of limited value and it remains to be seen whether newer 68Ga-labeled somatostatin analogs will perform better than OCT.

A Phase I Clinical Trial of Ad5.SSTR/TK.RGD, a Novel Infectivity-Enhanced Bicistronic Adenovirus, in Patients with Recurrent Gynecologic Cancer

Ad5.SSTR/TK.RGD is an infectivity-enhanced adenovirus expressing a therapeutic thymidine kinase suicide gene and a somatostatin receptor (SSTR) that allows for noninvasive gene transfer imaging. The purpose of this study was to identify the maximum tolerated dose (MTD), toxicities, clinical efficacy, and biologic effects of Ad5.SSTR/TK.RGD in patients with recurrent gynecologic cancer. Eligible patients were treated intraperitoneally for 3 days with 1 × 10(9) to 1 × 10(12) vp/dose of Ad5.SSTR/TK.RGD followed by intravenous ganciclovir for 14 days. Toxicity and clinical efficacy were assessed using Common Toxicity Criteria (CTC) Adverse Events grading and Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Imaging using In-111 pentetreotide was obtained before and after treatment. Tissue samples were obtained to evaluate for gene transfer, generation of wild-type virus, viral shedding, and antibody response. Twelve patients were treated in three cohorts. The most common vector-related clinical toxicities were grade I/II constitutional or pain symptoms, experienced most often in patients treated at the highest dose. MTD was not identified. Five patients showed stable disease; all others experienced progressive disease. One patient with stable disease experienced complete resolution of disease and normalization of CA125 on further follow-up. Imaging detected increased In-111 pentetreotide retention in patients treated at the highest dose. Ancillary studies showed presence of Ad5.SSTR/TK.RGD virus and HSV1-tk expression in ascites samples collected at various time points in most patients treated within the higher dose cohorts. This study shows the safety, potential efficacy, and possible gene transfer imaging capacity of Ad5.SSTR/TK.RGD in patients with recurrent gynecologic cancer. Further development of this novel gene therapeutic appears to be warranted.

Molecular imaging of adrenal neoplasms.

The adrenal glands are complex structures from which a variety of benign and malignant tumors may arise and are a common site of metastatic disease. Several radiopharmaceuticals are used for imaging the adrenals, including I-123/I-131 metaiodobenzylguanidine (MIBG), norcholesterol derivatives, In-111 pentetreotide and Ga-68 somatostatin analogs, [F-18]fluorodeoxyglucose, [F-18]fluorodopa, [F-18]fluorodopamine, C-11 meta hydroxyephedrine, and C-11/F-18/I-123 Metomidate (MTO) or its analogs. In this review we focus on the role of these reagents in metastatic lesions, cortical neoplasms, pheochromocytoma/paraganglioma, and neuroblastoma (NB).

Cervical and Upper Mediastinal Lymph Node Metastasis from Gastrointestinal and Pancreatic Neuroendocrine Tumors: True Incidence and Management

The incidence, clinical importance, and optimal management of cervical and upper mediastinal lymph node metastasis from gastrointestinal and pancreatic neuroendocrine tumors (NETS) are largely unknown. Historically, cervical nodes have been regarded as asymptomatic and ignored. We hypothesized that these lesions have clinical implications and should be removed surgically. Consecutive (111)In pentetreotide scans (OctreoScan) performed at our institution from May 2008 to October 2010 were reviewed to determine the incidence of cervical and upper mediastinal lymph node metastases among patients with gastrointestinal and pancreatic NETs. The charts of surgically treated patients were reviewed to evaluate the clinical importance of these metastases and the subsequent outcomes of their surgical treatment. A total of 161 NET patients presented with positive OctreoScans. Fourteen patients (8.7%) scanned positive for cervical and upper mediastinal lymph node metastasis. Nine patients underwent surgical exploration; 8 had successful removal of their metastatic nodes. Seven had clinical symptoms that resolved after surgery. Cervical and upper mediastinal lymph node metastases from gastrointestinal and pancreatic NETs were seen in up to 8.7% of patients. In the past, these metastases were assumed to be insignificant and ignored. Our study clearly demonstrates that most, if not all, such metastases are symptomatic and their clinical implications should not be overlooked. Notably, these metastases can be easily and safely resected using radioguided surgery.

Somatostatin receptor subtypes 1-5 gene expression in multiple sites in the same individual.

182 Background: Metastatic tumors may be fundamentally different than the primary tumor. This phenomenon may partially explain resistance of metastatic disease to therapy. We evaluated the gene expression levels of somatostatin receptor subtypes 1-5 (SSTR 1-5) in patients with disseminated neuroendocrine tumors (NETS) undergoing cytoreduction of their primary tumor and its nodal and liver metastasis. Methods: We compared the gene expression levels for SSTR 1-5 in primary tumor and their nodal and liver metastasis. The small bowel primary (SB), a mesenteric lymph node (LN) and a liver metastasis and their normal tissue counterparts were evaluated in four patients. RNA samples from each tissue underwent gene expression analysis using a customized Real Time Quantitative PCR (RT-qPCR) gene array. Normal tissue gene expression was compared to that obtained from the tumor sample at each site. Results: SSTR 2 was overexpressed (four-fold or greater, p≤ 0.01) compared to control levels in 8/12 (67%) specimens; 4/4 (100%) of the liver specimens, 3/4 (75%) of the SB specimens, and 1/4 (25%) of the LN specimens. SSTR 2 gene overexpression was not observed in all three tumor sites in any patient. No tumor had SSTR 2 downregulation. SSTR 5 was overexpressed (four-fold or greater, p≤ 0.01) compared to control levels in 6/12 (50%) specimens; 3/4 (75%) of the liver specimens, 2/4 (50%) of the SB specimens, and 1/4 (25%) of the LN specimens. SSTR 5 gene expression was up-regulated in all three tumor sites in one individual. SSTR 5 was down-regulated (7-fold, p<0.01) in one LN specimen. Changes in gene expression levels of SSTR 3 and SSTR 4 showed inconsistency between tumor sites, whereas that of SSTR1 was observed only at the metastatic sites. Conclusions: These results explain the observed variability in somatostatin receptor expression seen in 111In pentetreotide scans in multiple tumor sites from the same individual. The observation that gene expression varies from metastasis to metastasis may also help explain the difficulty in designing therapies that cure patients rather than inducing partial remissions.

Long-Term Survival, Toxicity Profile, and role of F-18 FDG PET/CT scan in Patients with Progressive Neuroendocrine Tumors Following Peptide Receptor Radionuclide Therapy with High Activity In-111 Pentetreotide

Aim: To study the long term benefits, toxicity and survival rate in patients with neuroendocrine tumors receiving multiple cycles of high activity In-111 Pentetreotide therapy. Moreover, our secondary aim was to evaluate the value of F-18 FDG PET-CT scan as prognostic indicator in this group of patients.Background: Neuroendocrine tumors are a heterogeneous group of malignancies which are usually metastatic at diagnosis. Standard chemotherapy in these patients is associated with appreciable adverse events and low effectiveness. Since 1990s, Peptide receptor radionuclide therapy (PRRT) with radio-labeled somatostatin analogues has been introduced as a new method of treatment in patients with unresectable and/or metastatic neuroendocrine tumors expressing high levels of Somatostatin receptors.Methods: 112 patients with progressive disseminated and unresectable neuroendocrine tumor (stage III and stage IV) were enrolled in a non-randomized trial in an out-patient setting. High activity In-111 Pentetreotide (500 mCi (18.5 GBq) per cycle) was administered as an intravenous infusion over 3 hours and repeated therapy cycles every 9-12 weeks in eligible patients up to maximum of 4 cycles. Response to therapy was evaluated by clinical imaging using the RECIST criteria, metabolic criteria and patient's quality of life questionnaire. Dosimetry and biodistribution studies were also performed. Finally, Kaplan-Meier survival analysis was performed for patients followed for greater than 12 months. The relationship between pretreatment F-18 FDG PET-CT scan status and survival was determined by two-tailed Student's t-test in 42 patients who underwent pre-therapy PET scans.Results: For an average of 25 (median 18.65) months following the therapy, patients were evaluated for any evidence of toxicity. No significant acute toxicity was observed in patients. Grade II or III hematological toxicity (7.6% of patients), liver toxicity (18.4%) and also grade I renal toxicity (6.1%) was observed in 92 evaluable patients. Radiological responses were evaluated for an average of 29 months following their last cycle of therapy and results were analyzed by the RECIST criteria. Majority (85%) of patients had stable disease (SD), partial response (PR) rate was 7.5% and progressive disease (PD) was observed in 7.5% of patients. The average survival was 24.67 months after 2 cycles of therapy, 30.53 months after 3 cycles of therapy and 30.19 months after 4 cycles of therapy. Of the 42 patients who had pretreatment PET-CT imaging, 31 patients had positive F-18 FDG scans (SUV > 2.5) with an average survival time of 18.9 months (range 1.4-45.8 months) and 11 patients had negative F-18 FDG scans (SUV ≤ 2.5) with an average survival time of 31.8 months (range 7.4-42.9 months). Survival times for FDG negative patients were significantly longer than those for FDG positive patients (p = 0.001 with 95% confidence).Conclusion: High activity In-111 therapy is a safe and effective therapy for patients with progressive disseminated neuroendocrine tumors. No major hematological, renal and hepatic toxicities were observed. There was an increase in survival time particularly in patients with lower degree of liver involvement as well as patients who received three or more cycles of therapy, as compared to historical data. Pre-treatment FDG status may be a predictor of survival following In-111 pentetreotide therapy.

Neuroendocrine Tumors: A Focus on Liver Metastatic Lesions

Transhepatic radionuclide infusion has been introduced as a new treatment approach for unresectable liver neuroendocrine metastatic lesions with the prerequisite of a positive In-111 Pentetreotide (Octreoscan). Patients with multiple liver neuroendocrine metastases can be locally treated after selective hepatic artery catheterization and infusion of radiolabeled somatostatin analogs, and in case of extra-hepatic secondary spread, after simple i.v. application. According to the world wide references, the average dose per session to each patient is 6.3 ± 0.3 GBq (∼160–180 mCi) of In-111-DTPA-Phe1-Pentetreotide, 10- to 12-fold in total, administered monthly or of 4.1 ± 0.2 GBq (∼105–116 mCi) of Y-90 DOTA TOC, threefold in total, or of 7.0 ± 0.4 GBq (∼178–200 mCi) of Lu-177 DOTA TATE, fourfold to sixfold in total (the choice of which being based on the tumor size, assessed by CT or MRI). Follow-up at monthly intervals has to be performed by means of ultrasonography (US). Treatment response has to be assessed according to the WHO criteria (RECIST or SWOG).

Role of In-111 Pentetreotide in Differentiating Carcinoid Tumours from Sarcoidosis

Role of In-111 Pentetreotide in Differentiating Carcinoid Tumours from Sarcoidosis

Role of In-111 Pentetreotide in Differentiating Carcinoid Tumours from Sarcoidosis

Role of In-111 Pentetreotide in Differentiating Carcinoid Tumours from Sarcoidosis

In-111 Pentetreotide Uptake in a Uterine Myoma

In-111 Pentetreotide Uptake in a Uterine Myoma

Long-term survival and toxicity profile of patients with disseminated neuroendocrine tumors following multiple cycles of high activity 111In pentetreotide therapy.

e13545 Background: We have previously reported clinical response to multiple doses of high activity 111In pentetreotide in patients with disseminated neuroendocrine tumors. Here we report long term renal toxicity and survival following multiple 500 mCi doses of 111In-pentetreotide. Methods: In a nonrandomized trial, 83 patients (50 men, 33 women) with disseminated neuroendocrine tumor (stages III to IV) received 500mCi doses of In-111 pentetreotide therapy without co-administration of amino acid solution. Twenty-one patients received one therapy with an average dose of 489mCi/patient (390-513 mCi) and average renal dose of 330 rad (134-712 rad). Forty-one patients received two cycles of therapies with an average dose 977mCi/patient (893-1,012 mCi/patient) and cumulative renal dose of 566 rad (63-578 rad). Twenty-one patients received three therapies with an (average dose 1,464 mCi/patient (1,419-1,495mCi) and cumulative average renal dose of 665 rad (329-2,273 rad). Patients were evaluated for evidence of renal toxicity using NCI common toxicities criteria and followed for an average of 28.64 months (1.2-50.6 months). For patients with more than one therapy, data is reported after the last cycle of therapy. Kaplan Meyer survival analysis was conducted on 65 patients followed for 12 months or more. Results: Four patients had grade 1renal toxicity immediately following therapy. Of these patients 1 patient received 1 therapy, 1 patient received 2 therapies and 2 patients received 3 therapies. There were no reports of significant renal toxicity. No correlation to absorbed kidney dose was found. Average survival time was 23.4 months (1.2-50.6 months). Conclusions: Multiple 500 mCi doses of 111In-pentetreotide therapy are effective in patients with progressive disseminated neuroendocrine tumors, with minor acute renal toxicity. No long-term toxicity was observed at doses up to 1,495 mCi/ patient. The toxicity profile of this regimen suggests the opportunity for further dose escalation. No significant financial relationships to disclose.