Comparing PRRT Agents in Neuroendocrine Tumors

Comparing PRRT Agents in Neuroendocrine Tumors: Toxicity and Survival

A recent study analyzed renal and hematological toxicities and survival outcomes in neuroendocrine tumor patients treated with two different peptide receptor radionuclide therapy agents. The findings reveal that while renal toxicity was minimal, minor hematological toxicity occurred, and progression-free survival differed between the treatments.

Key Findings:

• Renal function remained stable, with no significant renal toxicity observed with either PRRT agent.
• Patients receiving ¹⁷⁷Lu-DOTATATE experienced minor hematological toxicity, including decreased white blood cell and platelet counts.
• Treatment with ¹⁷⁷Lu-DOTATATE improved progression-free survival compared to ⁹⁰Y-DOTATOC.
• No significant difference in overall survival was observed between the two treatments.
• The study suggests monitoring hematological function during PRRT with ¹⁷⁷Lu-DOTATATE.

Peptide receptor radionuclide therapy (PRRT) is a treatment option for patients with metastatic neuroendocrine tumors (NETs). A recent study published in the Journal of Cancer Research and Clinical Oncology evaluated the renal and hematological toxicities associated with two PRRT agents: ¹⁷⁷Lu-DOTATATE and ⁹⁰Y-DOTATOC, and their impact on patient survival.

Introduction: Studies on PPRT Toxicities, Timing, and Survival Benefits Lacking

Renal and hematological toxicities are known side effects of PRRT, potentially limiting its therapeutic use. Understanding these toxicities may be important for improving patient outcomes. Additionally, optimal timing and survival benefits of PRRT have not been thoroughly examined. This study looked at changes in renal and hematological function in NET patients treated with PRRT and examined associations with overall survival (OS) and progression-free survival (PFS).

Methods: Multi-Center Retrospective Cohort Design

The researchers conducted a retrospective cohort study involving 448 NET patients from two U.S. medical centers. Among these patients, 335 received ¹⁷⁷Lu-DOTATATE (approximately 75%), and 113 were treated with ⁹⁰Y-DOTATOC (approximately 25%). Renal function was monitored through serum creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Hematological function was measured by white blood cell counts, platelet counts, and hemoglobin levels over time. Piecewise linear mixed-effect models were used to analyze longitudinal changes, and survival outcomes were evaluated using Cox proportional hazard regressions.

Results: Minimal Renal, Minor Hematological Toxicities Observed

The study found no significant differences in renal function between patients treated with ¹⁷⁷Lu-DOTATATE and those treated with ⁹⁰Y-DOTATOC prior to, during, or after PRRT. However, patients receiving ¹⁷⁷Lu-DOTATATE showed significantly decreased indicators of hematological function before and during treatment. Specifically, there was a decrease in white blood cell counts (estimate: -0.10, 95% confidence interval (CI): -0.15 to -0.05; P < 0.001) and platelet counts (estimate: -2.53, 95% CI: -3.83 to -1.24; P < 0.001). No significant recovery in hematological function was observed post-treatment.

Conclusions: ¹⁷⁷Lu-DOTATATE Enhanced Progression-Free Survival Without Affecting Overall Survival

While minor hematological toxicity was associated with ¹⁷⁷Lu-DOTATATE, this agent appeared to improve progression-free survival compared to ⁹⁰Y-DOTATOC (hazard ratio for PFS: 0.47, 95% CI: 0.28–0.79, P = 0.004). There was no significant difference in overall survival between the two treatments. The study concluded that treatment with ¹⁷⁷Lu-DOTATATE may require monitoring for hematological toxicity, regardless of prior therapies.

 Comparing PRRT Agents in Neuroendocrine Tumors: Understanding Toxicity and Survival Outcomes

Peptide Receptor Radionuclide Therapy (PRRT) has emerged as a promising treatment option for patients with metastatic neuroendocrine tumors (NETs). A recent study offers valuable insights into the safety and efficacy of two commonly used PRRT agents—177Lu-DOTATATE and 90Y-DOTATOC—focusing on their renal and hematological toxicities and survival outcomes. These findings shed light on optimizing treatment strategies and improving patient care.

Minimal Renal Toxicity

Both agents demonstrated stable renal function throughout the study, highlighting the minimal risk of kidney damage with PRRT.

Hematological Toxicity

• 177Lu-DOTATATE: Associated with a decline in white blood cell and platelet counts, especially during treatment.
• Recovery: Post-treatment recovery in hematological function was limited, emphasizing the need for regular monitoring.

Progression-Free Survival (PFS)

Patients treated with 177Lu-DOTATATE experienced significantly longer PFS compared to 90Y-DOTATOC, indicating its efficacy in delaying disease progression.

Conclusion: Advancing PRRT for Neuroendocrine Tumors

This study underscores the importance of balancing safety and efficacy in PRRT for NET patients. By identifying minimal renal toxicity and manageable hematological side effects, particularly with 177Lu-DOTATATE, it paves the way for tailored treatment strategies. Regular monitoring and patient-specific approaches will be key to optimizing outcomes in this evolving field of oncology.

Visit our website today to uncover: Comparing PRRT Agents in Neuroendocrine Tumors: Toxicity and Survival