Paper of the Month March 2020

Broadening horizons with ²²⁵Ac-DOTATATE targeted alpha therapy for gastroenteropancreatic neuroendocrine tumour patients stable or refractory to ¹⁷⁷Lu-DOTATATE PRRT: first clinical experience on the efficacy and safety

Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/31707430

Journal: https://link.springer.com/article/10.1007%2Fs00259-019-04567-2

Comment

The paper presents the first clinical experience on efficacy and safety of ²²⁵Ac-DOTATATE in patients with gastroenteropancreatic neuroendocrine tumour stable or refractory to ¹⁷⁷Lu-DOTATATE PRRT.

It is a well-constructed, but limited, prospective study, in which the response was assessed using different scoring systems. The primary end point of the study was objective tumour response by RECIST 1.1 criteria. Secondary end points included biochemical response, adverse event profile,

and clinical response assessment by the EORTC quality-of-life questionnaire. In parallel, treatment-related adverse events were recorded according to the CTCAE V5 criteria.

The morphological response assessed in 24/32 patients (62.5% partial remission and 37.5% stable disease ) revealed no tumour progression or deaths within the median follow-up of 8 months whereas there was a significant decrease in the plasma chromogranin level post-therapy.

Post therapy, the patient had clinically a marked decrease of endocrine and gastrointestinal symptoms as well as disease-related worries, whereas a significant increase in the treatment-related symptoms was observed. None of the patients encountered grade III/IV haematological, renal, or hepatotoxicity as well as tumour lysis syndrome.

This paper illustrates the potential benefit, with a good safety profile, of alpha therapy in patients with gastroenteropancreatic neuroendocrine tumour who have exhausted or are refractory to all therapeutic options, including beta-emitting ¹⁷⁷Lu-DOTATATE therapy.

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