Cardiotoxicity and cardiac monitoring following the use of radiotheranostics agents including ¹⁷⁷Lu-PSMA for prostate cancer and ¹⁷⁷Lu-DOTATATE for neuroendocrine tumors

Abstract

Background The aim of this study was to determine the probable cardiotoxicity following radionuclide therapy (RNT), specifically peptide receptor radionuclide therapy (PRRT) with ¹⁷⁷Lu-DOTATATE and radioligand therapy (RLT) with ¹⁷⁷Lu-PSMA by evaluation of serum troponin I and cardiac profile change during a follow-up time.

Materials and Methods Patients with prostate cancer and neuroendocrine tumours (NETs) referred for PRRT and RLT, respectively, were enrolled in this study. The cardiac profiles of the patients were evaluated by a cardiologist and a cardiac history was obtained from all patients. Also, troponin I was measured before and 48 hours after treatment.

Results In this retrospective study for assessment of RLT associated cardiotoxicity, 24 patients were evaluated with a median age of 64 years (27–99 years) including 13 NET patients and 11 prostate cancer patients. Patients were followed up for 4 to 31 months which no cardiovascular problem was observed. In evaluation of troponin I, 39 RNT cycles were evaluated. In all patients, the value of troponin I was in normal range. In all patients, the median values of serum troponin I before and after treatment were 0.2 ± 0.02 (range: 0.00–0.42) and 0.28 ± 0.02 (range: 0.00–0.46) ng/ml, respectively (p > 0.05). In the prostate cancer patients, the median values of serum troponin I before and after treatment were 0.26 ± 0.04 (0.04–0.42) and 0.30 ± 0.04 (0.00–0.41) ng/ml, respectively (p > 0.05). In the NET patients, the median values of serum troponin I before and after treatment were 0.18 ± 0.03 (0.00–0.42) and 0.17 ± 0.03 (0.00–0.46) ng/ml, respectively (p > 0.05).

Conclusion PRRT with ¹⁷⁷Lu-DOTATATE and RLT with ¹⁷⁷Lu-PSMA as emerging therapeutic modalities have no significant cardiotoxicity. However, further well-designed studies are recommended.

Zusammenfassung

Hintergrund Ziel dieser Studie war die Bestimmung der voraussichtlichen Kardiotoxizität nach Radionuklidtherapie (RNT), speziell der Peptidrezeptor-Radionuklidtherapie (PRRT) mit ¹⁷⁷Lu-DOTATATE und der Radioligandentherapie (RLT) mit ¹⁷⁷Lu-PSMA durch Bewertung von Serum-Troponin I und der kardialen Profilveränderung während einer Nachbeobachtungszeit.

Material und Methoden Patienten mit Prostatakrebs und neuroendokrinen Tumoren (NETs), die zur PRRT bzw. RLT überwiesen wurden, wurden in diese Studie eingeschlossen. Die kardialen Profile der Patienten wurden von einem Kardiologen beurteilt und von allen Patienten wurde eine kardiale Anamnese erhoben. Außerdem wurde Troponin I vor und 48 Stunden nach der Behandlung gemessen.

Ergebnisse In dieser retrospektiven Studie zur Beurteilung der RLT-assoziierten Kardiotoxizität wurden 24 Patienten mit einem medianen Alter von 64 Jahren (27–99 Jahre) untersucht, darunter 13 NET-Patienten und 11 Prostatakrebspatienten. Die Patienten wurden für 4–31 Monate nachbeobachtet, wobei keine Herz-Kreislauf-Probleme beobachtet wurden. Bei der Bewertung von Troponin I wurden 39 RNT-Zyklen ausgewertet. Bei allen Patienten lag der Wert von Troponin I im Normalbereich. Bei allen Patienten lagen die medianen Werte von Serum-Troponin I vor und nach der Behandlung bei 0,2 ± 0,02 (Bereich: 0,00–0,42) bzw. 0,28 ± 0,02 (Bereich: 0,00–0,46) ng/ml (p > 0,05). Bei den Prostatakrebspatienten betrugen die medianen Werte von Serum-Troponin I vor und nach der Behandlung 0,26 ± 0,04 (0,04–0,42) bzw. 0,30 ± 0,04 (0,00–0,41) ng/ml (p > 0,05). Bei den NET-Patienten betrugen die Medianwerte von Serum-Troponin I vor und nach der Behandlung 0,18 ± 0,03 (0,00–0,42) bzw. 0,17 ± 0,03 (0,00–0,46) ng/ml (p > 0,05).

Schlussfolgerung PRRT mit ¹⁷⁷Lu-DOTATATE und RLT mit ¹⁷⁷Lu-PSMA als neue therapeutische Modalitäten weisen keine signifikante Kardiotoxizität auf. Weitere gut konzipierte Studien werden jedoch empfohlen.

Key words

troponin - cardiovascular toxicity - peptide receptor radionuclide therapy (PRRT) - ¹⁷⁷Lu-DOTATATE - radioligand therapy (RLT) - ¹⁷⁷Lu-PSMA

Schlüsselwörter

Troponin - kardiovaskuläre Toxizität - Peptidrezeptor-Radionuklidtherapie (PRRT) - ¹⁷⁷Lu-DOTATATE - Radioligandentherapie (RLT) - ¹⁷⁷Lu-PSMA

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