Z Gastroenterol 2013; 51 - A78
DOI: 10.1055/s-0033-1347528

Our experiences with 90Y-DOTATOC therapy for neuroendocrine tumors (NETS)

A Uhlyarik 1, I Szilvási 2, T Gyökeres 3, L Torday 4, D Wilde 5, Z Pápai 1
  • 1Medical Centre Hungarian Defence Forces, Department of Oncology
  • 2Medical Centre Hungarian Defence Forces, Department of Nuclear Medicine
  • 3Medical Centre Hungarian Defence Forces, Department of Gastroenterology
  • 4University of Szeged, Department of Oncotherapy
  • 5Nuclear Medicine University Hospital Basel

In the last 30 years the incidence of neuroendocrine tumors showed a five fold increase. This disease group includes tumors with heterogeneous behavior, and the treatment may differ significantly. The WHO's 2010 classification based on pathological characteristics provides the basis of treatment. Among the non-surgical therapeutical options, in addition to somatostatin analogues, interferons, endoradiotherapy and chemotherapeutic agents, targeted therapies including tyrosine kinase and m-TOR inhibitors have also appeared. Clinical studies proved that the long-acting somatostatin analogue Sandostatin LAR has anti-tumor activity as well,which is independent of the octeroscan positivity. DOTATOC isotope endoradiotherapy is not available in Hungary; however for our patients it was accessible abroad. Between August 2010 and December 2012, a total of 10 patients received isotope therapy.

The average age of the 8 female and 2 male patients was 57.5 years. The localization of the primary tumors was as follows: pancreas 3,small intestine 3, lung 1, stomach 1, colon 1, and 1 in the rectum. Based on the grade of histological differentiation, 4 patients belonged to the G1, 5 to the G2, and 1 to the G3 group. 5 patients had only liver, and 1 only lymph node metastasis. 4 patients with liver involvement had metastasis in multiple organs,1 patient had lymph node and 1 had breast metastasis,and 2 patients had bone metastasis. Development of carcinoid syndrome was seen in 6 patients.

As a response to the DOTATOC therapy 1 complete remission and 1 partial response were proven, 6 patients experienced disease stabilisation, and 2 patient had progression. The disease control rate (DCR) was 80% (CR 10%, PR 10%, SD 60%). Progression-free survival (PFS) was evaluated after 2 cycles of Yttrium DOTATOC therapy. Currently 2 patients are still stable. The mean PFS of 6 evaluable patients was 16.7 months. The side effect profile was very favorable; the most frequent acute side effects included nausea and vomiting, while renal and hematological toxicity occurred as a late adverse event in the case of 1 patient.

Our experience with Yttrium DOTATOC therapy is identical to the literature results with respect to both the disease control rate (DCR) and the PFS. For the treatment of neuroendocrine tumors DOTATOC therapy is an effective option with favorable side effect profile.