Peptide receptor radionuclide therapy (PRRT) in patients with giant aggressive pituitary tumors: experience of an Italian referral center and review of literature

2019 ◽  
Author(s):  
Giuseppe Giuffrida ◽  
Francesco Ferrau ◽  
Riccardo Laudicella ◽  
Oana Ruxandra Cotta ◽  
Antonio Vento ◽  
...  
Keyword(s):  
Radionuclide Therapy ◽  
Pituitary Tumors ◽  
Peptide Receptor Radionuclide Therapy ◽  
Review Of Literature ◽  
Peptide Receptor ◽  
Referral Center

scholarly journals Peptide receptor radionuclide therapy for aggressive pituitary tumors: a monocentric experience

2019 ◽  
Vol 8 (5) ◽  
pp. 528-535 ◽  
Author(s):  
G Giuffrida ◽  
F Ferraù ◽  
R Laudicella ◽  
O R Cotta ◽  
E Messina ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Radionuclide Therapy ◽  
Therapeutic Option ◽  
Pituitary Tumors ◽  
Peptide Receptor Radionuclide Therapy ◽  
Tumor Shrinkage ◽  
Long Term Outcome ◽  
Peptide Receptor ◽  
Giant Prolactinoma

In aggressive pituitary tumors (PT) showing local invasion or growth/recurrence despite multimodal conventional treatment, temozolomide (TMZ) is considered a further therapeutic option, while little data are available on peptide receptor radionuclide therapy (PRRT). We analyzed PRRT effectiveness, safety and long-term outcome in three patients with aggressive PT, also reviewing the current literature. Patient #1 (F, giant prolactinoma) received five cycles (total dose 37 GBq) of 111In-DTPA-octreotide over 23 months, after unsuccessful surgery and long-term dopamine-agonist treatment. Patient #2 (M, giant prolactinoma) underwent two cycles (12.6 GBq) of 177Lu-DOTATOC after multiple surgeries, radiosurgery and TMZ. In patient #3 (F, non-functioning PT), five cycles (29.8 GBq) of 177Lu-DOTATOC followed five surgeries, radiotherapy and TMZ. Eleven more cases of PRRT-treated aggressive PT emerged from literature. Patient #1 showed tumor shrinkage and visual/neurological amelioration over 8-year follow-up, while the other PTs continued to grow causing blindness and neuro-cognitive disorders (patient #2) or monolateral amaurosis (patient #3). No adverse effects were reported. Including the patients from literature, 4/13 presented tumor shrinkage and clinical/biochemical improvement after PRRT. Response did not correlate with patients’ gender or age, neither with used radionuclide/peptide, but PRRT failure was significantly associated with previous TMZ treatment. Overall, adverse effects occurred only in two patients. PRRT was successful in 1/3 of patients with aggressive PT, and in 4/5 of those not previously treated with TMZ, representing a safe option after unsuccessful multimodal treatment. However, at present, considering the few data, PRRT should be considered only in an experimental setting.

scholarly journals Peptide Receptor Radionuclide Therapy and Primary Brain Tumors: An Overview

2021 ◽  
Vol 14 (9) ◽  
pp. 872
Author(s):  
Andrea Cimini ◽  
Maria Ricci ◽  
Francesca Russo ◽  
Martina Egidi ◽  
Ferdinando Calabria ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Radionuclide Therapy ◽  
Somatostatin Receptors ◽  
Pituitary Tumors ◽  
Peptide Receptor Radionuclide Therapy ◽  
Comprehensive Overview ◽  
Transmembrane Receptors ◽  
Peptide Receptor ◽  
Primary Brain Tumors ◽  
Cancer Types

Primary brain tumors (PBTs) are some of the most difficult types of cancer to treat, and despite advancements in surgery, chemotherapy and radiotherapy, new strategies for the treatment of PBTs are needed, especially for those with poor prognosis such as inoperable/difficult-to-reach lesions or relapsing disease. In regard to the last point, malignant primary brain tumors remain some of the most lethal types of cancer. Nuclear medicine may provide exciting new weapons and significant contributions in the treatment of PBTs. In this review, we performed literature research in order to highlight the possible role of peptide receptor radionuclide therapy (PRRT) in the treatment of PBTs with radiolabeled molecules that bind with high-affinity transmembrane receptors such as somatostatin receptors (SSTRs), neurokinin type-1 receptor and prostate-specific membrane antigen (PSMA). These receptors are overexpressed in some cancer types such as gliomas, meningiomas, pituitary tumors and medulloblastomas. A comprehensive overview of possible applications in this field will be shown, providing knowledge about benefits, feasibility, developments and limitations of PRRT in this type of tumor, also revealing new advantages in the management of the disease.

scholarly journals Synergism of Checkpoint Inhibitors and Peptide Receptor Radionuclide Therapy in the Treatment of Pituitary Carcinoma

2021 ◽  
Author(s):  
Andrew L Lin ◽  
Viviane Tabar ◽  
Robert J Young ◽  
Marc Cohen ◽  
John Cuaron ◽  
...  
Keyword(s):  
Partial Response ◽  
Radionuclide Therapy ◽  
Checkpoint Inhibitors ◽  
Pituitary Tumors ◽  
Peptide Receptor Radionuclide Therapy ◽  
Pituitary Carcinoma ◽  
Receptor Expression ◽  
External Beam Radiation ◽  
External Beam ◽  
Peptide Receptor

Abstract Introduction Aggressive pituitary tumors that have progressed following temozolomide have limited treatment options. Peptide receptor radionuclide therapy and immunotherapy may have a complementary role in the management of these tumors. Methods We provide follow-up data on a previously reported patient with a hypermutated recurrent tumor. The patient in this report provided written informed consent for tumor sequencing and review of medical records on an institutional review board approved research protocol (NCT01775072). Results This patient with a corticotroph pituitary carcinoma with alkylator induced somatic hypermutation has remained on treatment with ipilimumab and nivolumab for 3.5 years and remains clinically well. After an initial partial response to checkpoint inhibitors, she has had several recurrences that have undergone immunoediting of subclonal mutations, which have been effectively treated with continuation of immunotherapy, surgery, external beam radiation, and 177Lu-DOTATATE. Following external beam RT, she had radiographic evidence of an abscopal response at a distant site of disease suggesting a synergism between checkpoint inhibitors and radiotherapy. Following treatment with 177Lu-DOTATATE, the patient had a partial response with a 61% reduction in volume of the target lesion. Conclusion In patients with aggressive pituitary tumors, treatment with checkpoint inhibitors may trigger an abscopal response from radiotherapy. With appropriate selection, an additional efficacious treatment, 177Lu-DOTATATE, may be available for a limited number of patients with aggressive pituitary adenomas, including patients who have progressed on temozolomide and exhibit increased somatostatin receptor expression on 68Ga-DOTATATE PET.

Peptide Receptor Radionuclide Therapy for Pancreatic Neuroendocrine Tumours

2019 ◽  
Vol 12 (2) ◽  
pp. 126-134 ◽  
Author(s):  
Shahad Alsadik ◽  
Siraj Yusuf ◽  
Adil AL-Nahhas
Keyword(s):  
Side Effects ◽  
Effective Treatment ◽  
Radionuclide Therapy ◽  
Neuroendocrine Tumours ◽  
Peptide Receptor Radionuclide Therapy ◽  
Progression Free Survival ◽  
Treatment Modalities ◽  
Effective Treatment Option ◽  
Peptide Receptor ◽  
Pancreatic Neuroendocrine Tumours

Background: The incidence of pancreatic Neuroendocrine Tumours (pNETs) has increased considerably in the last few decades. The characteristic features of this tumour and the development of new investigative and therapeutic methods had a great impact on its management. Objective: The aim of this review is to investigate the outcome of Peptide Receptor Radionuclide Therapy (PRRT) in the treatment of pancreatic neuroendocrine tumours. Methods: A comprehensive literature search strategy was used based on two databases (SCOPUS, and PubMed). We considered all studies published in English, evaluating the use of PRRT (177Luteciuim- DOTA-conjugated peptides and 90Yetrium- DOTA- conjugated peptides) in the treatment of pancreatic neuroendocrine tumours as a standalone entity or as a subgroup within the wider category of Gastroenteropancreatic Neuroendocrine Tumours (GEP NETs). Results: PRRT was found to be an effective treatment modality as a monotherapy or in combination with other therapies in the treatment of non-operable and metastatic pNETs where other options are limited. Complete response was reported to be between 2-6% while partial response was achieved in up to 60% of cases. Survival analysis was also impressive. Progression Free Survival (PFS) reached a mean of 34 months and Overall Survival (OS) of 53 months. PRRT also proved to improve patients’ Quality of Life (QoL). Acute and sub-acute side effects like nephrotoxicity and haematotoxicity are usually mild and reversible. Conclusion: PRRT is well tolerated and effective treatment option for non-operable and/or metastatic pNETs. Side effects are usually mild and reversible. Larger randomized controlled trails need to be done to compare PRRT with other treatment modalities and to provide more detailed guidelines regarding patient selections, the choice of PRRT, follow up and response assessment to maximum potential benefit.

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