Radiometabolic Therapy Research Articles

Care Pathway at a Cancer Center for the Administration of Radiometabolic Therapy with 177Lu-PSMA in Patients with Metastatic Castration-resistant Prostate Cancer.

To present a clinical care model for the administration of 177Lu-labeled prostate-specific membrane antigen (PSMA) in radiometabolic therapy for metastatic castration-resistant prostate cancer (mCRPC) at the National Cancer Institute (NCI) of Bogotá, Colombia. A care model was designed for patients with mCRPC based on the VISION study, a prospective, phase III, multicenter, open-label, randomized study in patients with positive 68Ga-PSMA positron emission tomography/computed tomography who had progressed to taxane and androgen therapy, to receive 177Lu-PSMA-617 combined with the best standard of care vs. the best standard of care alone. The care pathway provided to patients was developed by the Nuclear Medicine Group of the NCI and is the result of adjustments and improvements in the care process and the updating of the literature. A systematic and efficient care model was formalized and implemented for the administration of 177Lu-PSMA therapy in patients with mCRPC who had previously been treated with at least one androgen receptor pathway inhibitor and one or two taxane regimens, with evidence of disease progression. An optimized process of care based on the determinants of clinical outcomes was developed for patients who received this type of radiometabolic therapy.

Calibration of an environmental monitoring system for a radiometabolic therapy ward using Lu-177

Radiopharmaceuticals based on Lu-177 are finding increasing use in radiometabolic therapy. The ordinary practice requires radiation monitoring of the patient. To this end, detectors need to be calibrated in the geometry used and for the radioisotope used. This work presents an experimental investigation coupled with Monte Carlo calculations. This procedure yielded a calibration factor of practical use in everyday clinical practice.

Oncological Outcomes of Patients with High-Volume mCRPC: Results from a Longitudinal Real-Life Multicenter Cohort.

Registrative trials recommended the use of upfront chemotherapy in high-volume metastatic prostate cancer. We reported survival outcomes of patients with high-volume mCRPC treated with ARTA in a chemo-naïve setting compared to patients treated with chemotherapy as first-line from a longitudinal real-life multicenter series. We retrospectively collected data on mCRPC patients treated at six centers. The dataset was queried for high-volume disease (defined as more than 6 bone lesions or bulky nodes ≥ 5 cm). We compared the main clinical features of chemo-naïve versus chemo-treated patients. The Mann-Whitney U test and Chi-squared test were used to compare continuous and categorial variables, respectively. The Kaplan-Meier method was used to compare differences in terms of progression-free survival (PFS), cancer specific survival (CSS) and overall survival (OS) in an upfront ARTA or chemo-treated setting. Survival probabilities were computed at 12, 24, 48, and 60 months. Out of 216 patients, 88 cases with high-volume disease were selected. Sixty-nine patients (78.4%) received upfront ARTA, while 19 patients received chemotherapy as the first-line treatment option. Forty-eight patients received Abiraterone (AA), 21 patients received Enzalutamide (EZ) as the first-line treatment. The ARTA population was older (p = 0.007) and less likely to receive further lines of treatment (p = 0.001) than the chemo-treated cohort. The five-year PFS, CSS and OS were 60%, 73.3%, and 72.9%, respectively. Overall, 28 patients (31.8%) shifted after their first-line therapy to a second-line therapy: EZ was prescribed in 17 cases, AA in seven cases and radiometabolic therapy in four patients. Sixteen cases (18.2%) developed significant progression and were treated with chemotherapy. At Kaplan-Meyer analysis PFS, CSS and OS were comparable for upfront ARTA vs chemo-treated patients (log rank p = 0.10, p = 0.64 and p = 0.36, respectively). We reported comparable survival probabilities in a real-life series of high-volume mCRPC patients who either received upfront ARTA or chemotherapy. Patients primarily treated with chemotherapy were younger and more likely to receive further treatment lines than the upfront ARTA cohort. Our data support the use of novel antiandrogens as first line treatment regardless tumor burden, delaying the beginning of a more toxic chemotherapy in case of significant disease progression.

Predictive factors of success of radiometabolic therapy in Graves' disease

Predictive factors of success of radiometabolic therapy in Graves' disease

THERAGNOSTICS OF SAMARIUM-153-EDTMP IN PATIENTS BEARING PROSTATE CANCER AND OSSEOUS SECONDARIES: PALLIATIVE BUT ALSO TUMOURICIDAL

BACKGROUND: 153 The radionuclide samarium-153 ( Sm) in a chelated compound with ethylene-diamine-tetramethylene phosphonate (EDTMP) is mainly used as an alternative to palliative therapy of multifocal painful osseous metastases due to various primaries, especially 153 prostate, breast, lung cancer, and osteosarcoma. Considering novel aspects of chemical properties attributed to Sm, we aimed at evaluating the 153 outcomes of solitary versus repeated Sm-EDTMPor exclusive opiate therapy in patients with osseous secondaries from prostate cancer. MATERIALS AND METHODS: In the present retrospective study, we included three groups of patients with hormone-refractory prostate cancer (HRPC) and multiple painful osteoblastic or mixed secondaries conrmed by bone scintigraphy. Forty-three patients (Group A) received 2 153 consecutive intravenous (i.v.) administrations of Sm-EDTMP (37 MBq/kg of body weight each), twelve patients (Group B) received a solitary 153 i.v. dose Sm-EDTMP and 12 patients (Group C) used solely opiates due to exclusion criteria regarding radiometabolic therapy. RESULTS: 153 Pain palliation was reported by 90.7% of group Apatients after the second injection. The repeated dose of Sm-EDTMPimproved the duration of pain response to 24±6 versus 8±2 weeks of the single dose treatment plan, without signicant myelotoxicity. Group C patients were considered as non-responders owing to increased pain score and consumption of analgesics. CONCLUSION: 153 Arepeated-dose Sm-EDTMPtreatment scheme consistently provides enhanced pain alleviation, thereby preserving quality of 153 life in patients with skeletal metastases from HRPC. Interestingly, radiometabolic therapy with Sm-EDTMP effectuates tumouricidal implications, thus upgrading a palliative agent to a disease theragnostics-targeted modier, with anticipated survival benet.

P130 - SPECT/CT calibration for patient dosimetry in radiometabolic therapy with 177Lu-DOTATE

P130 - SPECT/CT calibration for patient dosimetry in radiometabolic therapy with 177Lu-DOTATE

P241 - Femur surgery and clinical management of a patient hospitalized after 131 iodine cancer radiometabolic therapy: dosimetry evaluations for healthcare personnel

P241 - Femur surgery and clinical management of a patient hospitalized after 131 iodine cancer radiometabolic therapy: dosimetry evaluations for healthcare personnel

Multidisciplinary practice guidelines for the diagnosis, genetic counseling and treatment of pheochromocytomas and paragangliomas

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic/parasympathetic neural ganglia, respectively. The heterogeneity in its etiology makes PPGL diagnosis and treatment very complex. The aim of this article was to provide practical clinical guidelines for the diagnosis and treatment of PPGLs from a multidisciplinary perspective, with the involvement of the Spanish Societies of Endocrinology and Nutrition (SEEN), Medical Oncology (SEOM), Medical Radiology (SERAM), Nuclear Medicine and Molecular Imaging (SEMNIM), Otorhinolaryngology (SEORL), Pathology (SEAP), Radiation Oncology (SEOR), Surgery (AEC) and the Spanish National Cancer Research Center (CNIO). We will review the following topics: epidemiology; anatomy, pathology and molecular pathways; clinical presentation; hereditary predisposition syndromes and genetic counseling and testing; diagnostic procedures, including biochemical testing and imaging studies; treatment including catecholamine blockade, surgery, radiotherapy and radiometabolic therapy, systemic therapy, local ablative therapy and supportive care. Finally, we will provide follow-up recommendations.

POS-427 WHIPPLE DISEASE IN A PATIENT WITH MEMBRANOUS GLOMERULONEPHRITIS: FIRST CASE IN LITERATURE

The Whipple Disease (WD) is an extremely rare infective condition with an incidence of one individual in a million people1, mainly attributed to the Tropherima Whipplei (TW). It is described as a gram-positive belonging to the family of Actinomycetes.Along with other factors, the genetic plays its role through the immunological hyperactivity towards TW. Here we report an atypical presentation of this disease, in a patient admitted to our Department several times. Male patient, 46 years old, affected by essential epilepsy, treated with Carbamazepine, and a serum-negative rheumatoid arthritis treated with NSAID. The patient reported a right-sided hearing loss due to suspected viral infection and had a history of papillary thyroid carcinoma, treated with a total thyroidectomy and radiometabolic therapy. The patient was hospitalized to our Nephrology Unit for the onset of a nephrotic syndrome (24h-proteinuria 13640 mg/day) and US-guided renal biopsy was performed, where leading to a histological diagnosis of Membranous Nephropathy (MN) with high titre of serum PLA2R antibodies and normal kidney function (Tab.1). Because of his personal history of neoplasia, we could not follow KDIGO guidelines recommendations for MN, which indicate a first-line treatment with an alkylating agent alternated with cortisone for six months2.Therefore we opted for a treatment with mycophenolate of 2g/die. Due to the failed remission, we started a treatment with Rituximab.The patient has been hospitalized three more times for the onset of dyspepsia, anaemia, joint pain, weight loss, diarrhea and fever, which have been studied by the following examinations (Tab. 2). In particular, a diffuse lymphangiectasia was highlighted at the second esophagogastroduodenoscopy (EGD) performed (Fig. 1). The last EGD revealed a flocculating appearance of the second duodenal portion mucosa, resembling grain of millet. The histological examination noted the presence of massive macrophage infiltration and a slight shortening of the villi. The pictures were perfectly compatible with the diagnosis of WD (Fig 2.). The patient undertook antibiotic therapy with doxycycline 200 mg/day in combination with hydroxychloroquine 600 mg/day with a maintenance dosage of prednisone 5 mg/day. After two months, he reached the complete remission of joint and gastrointestinal manifestations with improvement of renal parameters: albuminemia raised of 13% (2.75 mg/dl), and 24h-proteinuria reduced of 60% (3596 mg). The WD diagnosis and the response to the therapy clarified the pathogenesis of other symptoms previously attributed to other idiopathic different diseases. Therefore, we assume that these manifestations may be caused by the overlapping action of the autoimmune renal pathology and WD.

Natural History and Management of Familial Paraganglioma Syndrome Type 1: Long-Term Data from a Large Family.

Head and neck paragangliomas are the most common clinical features of familial paraganglioma syndrome type 1 caused by succinate dehydrogenase complex subunit D (SDHD) mutation. The clinical management of this syndrome is still unclear. In this study we propose a diagnostic algorithm for SDHD mutation carriers based on our family case series and literature review. After genetic diagnosis, first evaluation should include biochemical examination and whole-body imaging. In case of lesion detection, nuclear medicine examination is required for staging and tumor characterization. The study summarizes the diagnostic accuracy of different functional imaging techniques in SDHD mutation carriers. 18F-3,4-dihydroxyphenylalanine (18F-DOPA) positron emission tomography (PET)-computed tomography (CT) is considered the gold standard. If it is not available, 123I-Metaiodobenzylguanidine (MIBG) could be used also for predicting response to radiometabolic therapy. 18F-fluoro-2-deoxy-D-glucose (18F-FDG) PET-CT has a prognostic role since high uptake identifies more aggressive cases. Finally, 68Ga-peptides PET-CT is a promising diagnostic technique, demonstrating the best diagnostic accuracy in our and in other published case series, even if this finding still needs to be confirmed in larger studies. Periodic follow-up should consist of annual biochemical and ultrasonographic screening and biannual magnetic resonance examination to identify biochemical silent tumors early.

Gold Nanoparticles and Nanorods in Nuclear Medicine: A Mini Review

In the last decade, many innovative nanodrugs have been developed, as well as many nanoradiocompounds that show amazing features in nuclear imaging and/or radiometabolic therapy. Their potential uses offer a wide range of possibilities. It can be possible to develop nondimensional systems of existing radiopharmaceuticals or build engineered systems that combine a nanoparticle with the radiopharmaceutical, a tracer, and a target molecule, and still develop selective nanodetection systems. This review focuses on recent advances regarding the use of gold nanoparticles and nanorods in nuclear medicine. The up-to-date advancements will be shown concerning preparations with special attention on the dimensions and functionalizations that are most used to attain an enhanced performance of gold engineered nanomaterials. Many ideas are offered regarding recent in vitro and in vivo studies. Finally, the recent clinical trials and applications are discussed.

Monte Carlo simulations of novel optical imaging methods for 131I radiometabolic therapy dosimetry

A new method for dosimetry and imaging (nodule size detection) in metabolic radiotherapy of thyroid gland with 131I is investigated using Monte Carlo simulations. Two approaches are compared, based on Cerenkov effect in human tissues and scintillation effect in a scintillator material placed on the detector. The feasibility is evaluated in terms of dosimetry and imaging performances, taking into account the patient variability and the geometrical configuration for the proposed detection device. The advantages and limitations are discussed with respect to the conventional approach. A good linear correlation between the number of photons and the absorbed dose was found for thyroid sick lobe (R2>0.95) and thyroid healthy lobe (R2>0.95) after gamma attenuation and optical absorption correction and for muscle (R2>0.94), while poorer results were found for skin (R2>0.85). No significant differences were found for Cerenkov and scintillation approach. The standard deviation of the nodule diameter was estimated 9.2 mm for Cerenkov approach and 7.4 nm for scintillation approach. The scintillator detector showed a definitely greater efficiency (a factor 104), as expected. The proposed geometry was combined with a Silicon Photomultiplier detector in order to overcome the low light yield in Cerenkov effect and the estimated total number of photons detected at the average of patient parameters was estimated 1.8× 108 for scintillation and 1.3 × 103 for Cerenkov.

102. Address the dosimetry in radiometabolic therapy; relationship between dosimetric value and clinical parameters in differentiated thyroid cancer

Purpose Use rationally the Red Marrow (RM) and Whole Body (WB) dosimetry pre and during therapy in Differentiated Thyroid Cancer (DTC) focalinzing the relationship between clinical parameters. Methods We enrolled 120 patients (278 dosimetries-196 with complete clinical data) with DTC (March 2012–December 2017). We made double dosimetric study the week before the therapy (19 MBq 131I) and during therapy (range 1019–9342 MBq, mean 6253 MBq, median 6208 MBq), collecting serial blood samples and WB counts according to the AIFM Italian dosimetric protocol and EANM SOP. With a simple regression analysis, we studied the capability of residence times (tau) and mGy/MBq (RM and WB) to predict the respective post therapy values (Fig. 1). We moreover considered a multivariate multiple regression model to control for clinical values (sex, age, histology, variant, multifocality, bilaterality, Tsh Ipo, Tg Ipo, FT4, staging and another tumour). Results All the variables pre-treatment have a significant role in explaining the levels of the corresponding variables post-treatment (Fig. 1). For all the variables, a PRE unitary increase determines a much smaller increase in post values (from 0.3 to 0.5). When considering all the variables as possible predictors (Table 1), none of them seems to have an effect on WBposttau, apart from WBpretau. For RMposttau, instead, we found correlation with RMpretau, WBpretau, age and the presence of another tumour. Concerning WBpostmGyMBq and RMpostmGyMBq, both appear to be reduced for N1b staging; WBpostmGyMBq reduced for advanced tumours and increased for large values of WBpretau. RMpostmGyMBq increases with age and RMpretau. A large parte of the total variability of WBpostmGyMBq and RMpostmGyMBq remains unexplained. Conclusions Dosimetry connected with clinical values could be a useful tool to help in patient management to predict behaviour and efficacy. Mandatory next step is to study follow up. Download : Download high-res image (220KB) Download : Download full-size image

332. Metastatic bone volume dose estimation procedure in 223Ra-Xofigo treatments

Purpose 223Ra-dichloride (BAYER Xofigo) radiometabolic therapy of bone metastatic lesions of castration-resistant prostate cancer seems to offer a valid alternative to conventional approaches, due to the alpha particles emitted in the tumor site. While a specific approach was developed to identify proper criteria for the morpho-functional assessment of activity distribution, a further step is needed to evaluate the local dose. Methods Preliminary gamma-camera calibrations (sensitivity and transmission curves) for 223Ra were performed. After estimating the metastatic activity and volume through scintigraphic images, the target absorbed dose is given by the ratio between energy and mass. While the latter can be evaluated from the same images, the local energy depends on the physical characteristics of the emitted radiation and the cumulated activity. In this way, both the energy per Bq released by each radiation type and its fraction locally deposited can be calculated. Cumulated activity requires data on the Xofigo kinetics over time, available in literature. Results Starting from the relative radiation emissions by 223Ra, 219Rn, 211Po, 211Bi and 207Tl the following MeV/Bq values were obtained: 26.3 alpha (95.33%), 1.0 beta (3.64%) and 0.3 X and gamma (1.03%). While charged particles energies are completely released to the biological mass, tissue absorption coefficients and target thickness must be considered for photons. By applying these criteria to a 118 cm3metastatic localization, a 0.35 MBq initial activity and a 4.73d effective half-life (see table and figures), the 6.7 Gy dose was obtained. This value concerns a Xofigo single dose administration and should be reconsidered for the entire treatment cycle. Conclusions The previous results are consistent with the literature. Their main advantage is the possibility to obtain immediate dose estimates, if the bone metastasis volume and its localized activity and time evolution are known. The experimental uncertainty is mainly related to volume and density of the metastatic tissue.

339. Radiometabolic treatment of hyperthyroidism after a patient specific dosimetric study: The radiation protection impact

Purpose Hyperthyroidism is a diffuse disease mainly treated with 131I-NaI radiometabolic therapy. Recently published data report that in Europe at least 15.000/y treatments are performed. As hyperthyroidism is a benign condition, the optimization principle stated in art.56 of 2013/59/Euratom Council Directive should be strongly applied and radiometabolic treatment should be performed with the minimum activity necessary to reach the clinical purpose minimizing the exposure of non-target tissues. Aim of the work was to evaluate the radioprotection impact of 131I therapies for hyperthyroidism after patient-specific dosimetric-studies, with respect to a standard administration of 600 MBq (max activity allowed in Italy for outpatient treatments). Methods 503 patients who solved hyperthyroidism within 1 year were considered (183 Graves, 383F, median age = 64y 17–89y]). Results Median 131I administered activity was 385 MBq [66–629 MBq] and only 29% of the patients had the maximum allowed activity. Total administered activity was 209 GBq; if the standard activity of 600 MBq had been administered to all patients total would have been 302 GBq, 45% greater than the really used one. This acts on the patient mean effective dose and on the mean absorbed dose to the stomach wall (critical organ for 131I-NaI/ICRP53) that were 5.8 Sv instead of 9.0 Sv and 177 mGy instead of 276 mGy respectively, with a maximum dose saving (9 times) for the patient who was given 66 MBq. The reduction of 131I administered activity also acts on the exposure of the nuclear medicine staff and of population: the mean dose rate at 1 m at the patient discharge time is 12 μSv/h instead of 20 μSv/h. This approach involves also the environment, as in the first 24 h 60% of administered activity is excreted. Conclusions The application of a patient specific pretreatment-dosimetric study can reduce of 45% the radioprotection impact of 131I treatments of hyperthyroidism with clinical results guaranteed and activity administered to the single patient can be decreased down to 9 times.

PET/CT With 68Ga-PSMA in Prostate Cancer: Radiopharmaceutical Background and Clinical Implications

In the last twenty years, positron emission tomography / computed tomography (PET/CT) with radiolabeled choline, represented the most powerful imaging modality for prostate cancer (PCa). However, the low positive detection rate of the technique for PSA < 1 ng/ml prompted the development of other tracers for imaging PCa. We performed a critical review of 68Ga-PSMA, a receptor ligand tracer, which has been identified as the most promising radiopharmaceutical for imaging PCa. The most promising feature of this radiopharmaceutical is the high positive detection rate for prostate specific antigen (PSA) levels < 1 ng/ml or less (i.e., PSA < 0.5 ng/ml). 68Ga-PSMA detection rate is also sensitive to PSA kinetics, expressed either as PSA doubling time or PSA velocity. There are initial results indicating that 68Ga-PSMA may significantly affect the clinical management of PCa patients, even though the additional advantages in comparison to radiolabeled choline need to be further supported in future perspective studies. Other clinical implications, such as whether 68Ga-PSMA PET/CT predicts PCa-specific survival, have not yet been investigated. Numerous clinical studies have been published, some of them with histopathological verification so that despite the recent introduction in the clinical field reliable estimation of sensitivity and specificity of 68Ga-PSMA PET/CT have been obtained through meta-analyses. Most clinical studies with PET/CT with 68Ga-PSMA are retrospective, single-institutional studies and in many cases include heterogeneous patient cohorts. Thus, multidisciplinary, well-throughout prospective trials are needed to better define the clinical implications of 68Ga- PSMA PET/CT in PCa patients. The increasing availability of positron emission tomography / magnetic resonance (PET/MR) hybrid devices promotes the use of this radiopharmaceutical especially at initial staging when identification of tumor localization and of extra-prostatic disease represent clinically relevant questions. PSMA cold ligands can also be labeled with beta emitters with good chemical stability so that 68Ga-PSMA PET/CT can be used to guide radiometabolic therapy of advanced metastatic PCa patients through 177Lu-labeled PSMA ligands. PSMA labeled ligands appear very promising for diagnosis and treatment of PCa.

Radiopharmaceuticals for the Diagnosis and Therapy of Neuroendocrine Differentiated Prostate Cancer.

Neuroendocrine differentiation of prostate cancer (PCa) is a relatively frequent event, generally understudied, that carries important prognostic information. It is the most frequently observed during the advanced stages of disease, when PCa has lost its sensitivity to androgen deprivation therapy or to chemotherapy, moderate to diffuse bone metastatic spread dominates the imaging scenario and it is responsible for painful clinical symptomatology. However, evidences indicate that neuroendocrine differentiation is a progressive phenomenon that starts at the very early part of the pathogenesis of cancer transformation contributing to it. Neuroendocrine tumor phenotypes have reduced capability to secrete the prostate specific antigen (PSA) and therefore PSA does not represent a reliable marker to follow-up neuroendocrine differentiation. Tumor progression may be monitored by measuring plasma concentration of neuroendocrine tumor markers, primarily chromogranin A and neuron-specific enolase. Several nuclear medicine tracers are available for studying different biochemical properties of tumor cells with neuroendocrine differentiation. Single photon computed emission tomography (SPECT) with [111In-diethylenetriaminepentaacetic acid] ([111In-DTPA0])- octreotide (Octreoscan) has been extensively used in the past. However, the development of the chelator 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA), which in comparison to DTPA allows higher affinity bindings for beta-emitting radionuclides and for somatostatin (SST) analogues, and the increased availability of the Germanium-68/Gallium-68 (68Ge/68Ga)-generator, which enables positron emission tomography/computed tomography (PET/CT) imaging, have allowed the synthesis of several PET tracers for different SST receptors. The receptor of the bombesin/ gastrin releasing peptide (GRP), which is overexpressed in PCa with neuroendocrine differentiation, also represents an innovative research field with diagnostic and therapeutic applications through, respectively, positron and beta emitters. At the moment, however, we observe some discrepancy between the high number of preclinical studies and the small number of clinical studies, most likely related to competing and, at the moment, more effective radiopharmaceuticals for imaging and for radiometabolic therapy, such PET/CT with radiolabeled choline and prostate-specific membrane antigene (PSMA)-ligands, the latter being labeled either with 68Ga for imaging or with Lutetium-177 for therapy. Radium-223 dichloride has also been recently successfully introduced for palliative therapy of bone metastases in PCa. For these reasons, while the development of radiopharmaceuticals for diagnosis and therapy (theranostics concept) of neuroendocrine differentiated PCa is scientifically stimulating, the ultimate clinical impact remains presently difficult to predict. Similar effectiveness in comparison to other forms of diagnostic and radiometabolic radiopharmaceuticals that have already gained convincing acceptance among referring clinicians needs to be demonstrated.

Incidental nodal metastasis of differentiated thyroid carcinoma in neck dissection specimens from head and neck cancer patients.

Occult differentiated thyroid carcinomas are not uncommon. The initial presentation of a thyroid carcinoma is often detection of a metastatic cervical lymph node. A retrospective review was performed of the medical records of 304 patients who underwent neck dissection between 1996 and 2008 for squamous cell carcinoma of the head and neck. Ten patients (3.3 per cent) had nodal metastasis originating from papillary thyroid cancer. All of these patients underwent thyroidectomy and post-operative 131iodine radiometabolic therapy. No patient developed a thyroid tumour after surgery. Despite its metastatic spread, thyroid cancer does not affect the overall prognosis of patients who are already being treated for a more aggressive malignancy. However, in otherwise healthy patients, it is worth treating this second malignancy to avoid potential complications related to local disease or metastatic thyroid cancer.

The safety and efficacy of enzalutamide in the treatment of advanced prostate cancer

ABSTRACTIntroduction: Enzalutamide – a non-steroidal second-generation antiandrogen – represents an active treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC) in both chemotherapy-naïve and docetaxel-pretreated settings, based on the demonstration of improved overall survival over placebo in two large phase III trials.Areas covered: The therapeutic landscape of mCRPC, narrowed to docetaxel until recently, encompasses now several treatments of a different nature (including androgen receptor targeting agents, taxanes, radiometabolic therapy, and immunotherapy), improving considerably the patients prognosis. However, direct comparisons between these agents still lack, raising the question of the optimal sequence of treatment.Expert commentary: We described in detail available data on clinical efficacy and safety of enzalutamide in different clinical settings (chemotherapy-naïve and -pretreated mCRPC patients), analyzing patients characteristics, the effects of enzalutamide on major clinical outcomes and its impact on patients quality of life. Finally, we briefly overviewed ongoing clinical trials evaluating potential active combinations, cross-resistance with other compounds, sequential strategies, and possible prognostic or predictive biomarkers.

C.376 - Radiometabolic therapy with 131I for hyperthyroidism from Graves' disease. First experiences in Sassari Hospital

C.376 - Radiometabolic therapy with 131I for hyperthyroidism from Graves' disease. First experiences in Sassari Hospital