2
|
Strosberg J, Kunz PL, Hendifar A, Yao J, Bushnell D, Kulke MH, Baum RP, Caplin M, Ruszniewski P, Delpassand E, Hobday T, Verslype C, Benson A, Srirajaskanthan R, Pavel M, Mora J, Berlin J, Grande E, Reed N, Seregni E, Paganelli G, Severi S, Morse M, Metz DC, Ansquer C, Courbon F, Al-Nahhas A, Baudin E, Giammarile F, Taïeb D, Mittra E, Wolin E, O'Dorisio TM, Lebtahi R, Deroose CM, Grana CM, Bodei L, Öberg K, Polack BD, He B, Mariani MF, Gericke G, Santoro P, Erion JL, Ravasi L, Krenning E. Impact of liver tumour burden, alkaline phosphatase elevation, and target lesion size on treatment outcomes with 177Lu-Dotatate: an analysis of the NETTER-1 study. Eur J Nucl Med Mol Imaging 2020; 47:2372-2382. [PMID: 32123969 PMCID: PMC7396396 DOI: 10.1007/s00259-020-04709-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the impact of baseline liver tumour burden, alkaline phosphatase (ALP) elevation, and target lesion size on treatment outcomes with 177Lu-Dotatate. METHODS In the phase 3 NETTER-1 trial, patients with advanced, progressive midgut neuroendocrine tumours (NET) were randomised to 177Lu-Dotatate (every 8 weeks, four cycles) plus octreotide long-acting release (LAR) or to octreotide LAR 60 mg. Primary endpoint was progression-free survival (PFS). Analyses of PFS by baseline factors, including liver tumour burden, ALP elevation, and target lesion size, were performed using Kaplan-Meier estimates; hazard ratios (HRs) with corresponding 95% CIs were estimated using Cox regression. RESULTS Significantly prolonged median PFS occurred with 177Lu-Dotatate versus octreotide LAR 60 mg in patients with low (< 25%), moderate (25-50%), and high (> 50%) liver tumour burden (HR 0.187, 0.216, 0.145), and normal or elevated ALP (HR 0.153, 0.177), and in the presence or absence of a large target lesion (diameter > 30 mm; HR, 0.213, 0.063). Within the 177Lu-Dotatate arm, no significant difference in PFS was observed amongst patients with low/moderate/high liver tumour burden (P = 0.7225) or with normal/elevated baseline ALP (P = 0.3532), but absence of a large target lesion was associated with improved PFS (P = 0.0222). Grade 3 and 4 liver function abnormalities were rare and did not appear to be associated with high baseline liver tumour burden. CONCLUSIONS 177Lu-Dotatate demonstrated significant prolongation in PFS versus high-dose octreotide LAR in patients with advanced, progressive midgut NET, regardless of baseline liver tumour burden, elevated ALP, or the presence of a large target lesion. Clinicaltrials.gov : NCT01578239, EudraCT: 2011-005049-11.
Collapse
Affiliation(s)
- Jonathan Strosberg
- Gastrointestinal Department/Neuroendocrine Tumor Division, Moffitt Cancer Center, Tampa, FL, USA.
| | - Pamela L Kunz
- Department of Medicine - Med/Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Andrew Hendifar
- Department of Internal Medicine/Hematology/Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - James Yao
- Department of Gastrointestinal Medicinal Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Bushnell
- Department of Radiology, The University of Iowa, Iowa City, IA, USA
| | - Matthew H Kulke
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Richard P Baum
- Department of Nuclear Medicine, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Martyn Caplin
- Department of Gastroenterology and Tumour Neuroendocrinology, Royal Free Hospital, London, UK
| | | | - Ebrahim Delpassand
- Department of Clinical Nuclear Medicine, Excel Diagnostics Imaging Clinic, Houston, TX, USA
| | - Timothy Hobday
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chris Verslype
- Department of Hepatology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Al Benson
- Hematology Oncology Division, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Rajaventhan Srirajaskanthan
- Department of Gastroenterology and General Internal Medicine, King's College Hospital - NHS Foundation Trust, London, UK
| | - Marianne Pavel
- Division of Hepatology and Gastroenterology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Jaume Mora
- Department of Nuclear Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jordan Berlin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - Nicholas Reed
- Department of Medical Oncology, Beatson Oncology Centre, Glasgow, UK
| | - Ettore Seregni
- Department of Nuclear Medicine Therapy and Endocrinology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Paganelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Stefano Severi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Michael Morse
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - David C Metz
- GI Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Ansquer
- Nuclear Medicine Department, Hôtel Dieu, University Hospital, Nantes, France
| | - Frédéric Courbon
- Medical Imaging, Oncology University Institut Claudius Regaud, Toulouse, France
| | - Adil Al-Nahhas
- Division of Imaging and Interventional Radiology, Imperial College London, London, UK
| | - Eric Baudin
- Department of Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France
| | - Francesco Giammarile
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - David Taïeb
- Department of Nuclear Medicine, Hôpital de la Timone, Marseille, France
| | - Erik Mittra
- Department of Nuclear Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Edward Wolin
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas M O'Dorisio
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Rachida Lebtahi
- Department of Nuclear Medicine, Royal Free Hospital, London, UK
| | - Christophe M Deroose
- Nuclear Medicine Department, University Hospitals and KU Leuven, Leuven, Belgium
| | - Chiara M Grana
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, Milan, Italy
| | - Lisa Bodei
- Department of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kjell Öberg
- Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Berna Degirmenci Polack
- Department of Medical Information, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Beilei He
- Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Maurizio F Mariani
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Germo Gericke
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Paola Santoro
- Department of Clinical Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Jack L Erion
- Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Laura Ravasi
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Eric Krenning
- Department of Nuclear Medicine, Cyclotron Rotterdam BV, Erasmus University Medical Center, Rotterdam, Netherlands
| | | |
Collapse
|