From the Guidelines
Lutetium-177 DOTATATE (Lutathera) is the recommended treatment for patients with inoperable or widespread neuroendocrine liver metastases, as it has been shown to improve progression-free survival and overall survival in these patients. This approach, called peptide receptor radionuclide therapy (PRRT), works by delivering targeted radiation directly to the tumor cells while sparing surrounding healthy tissue. The standard treatment regimen typically involves four infusions of Lutathera given approximately 8 weeks apart, with each session lasting several hours and requiring kidney protection with amino acid infusions 1.
The use of Lutetium-177 DOTATATE has been supported by several studies, including a phase III study (NETTER-1) that randomized 229 patients with advanced midgut NETs to receive treatment with either Lutetium-177 DOTATATE or high-dose octreotide, showing a significant improvement in progression-free survival (PFS) and objective tumor responses in the Lutetium-177 DOTATATE group 1. Another study examined the long-term efficacy, survival, and toxicity of Lutetium-177 DOTATATE in a group of 610 Dutch patients with metastatic gastroenteropancreatic (GEP) NETs and bronchial NETs, showing a PFS of 29 months and an overall survival (OS) of 63 months 1.
Some key points to consider when using Lutetium-177 DOTATATE for the treatment of neuroendocrine liver metastases include:
- The importance of proper patient selection, including the presence of somatostatin receptors on the tumor cells, as demonstrated by positive somatostatin receptor scintigraphy 1
- The need for kidney protection with amino acid infusions during treatment, as Lutetium-177 DOTATATE can cause nephrotoxicity 1
- The potential for objective tumor responses and improved survival outcomes, as demonstrated by several studies 1
Overall, Lutetium-177 DOTATATE is a valuable treatment option for patients with inoperable or widespread neuroendocrine liver metastases, and its use should be considered in the context of a multidisciplinary treatment approach.
From the Research
Definition of Dotatate
- Dotatate, also known as 177Lu-DOTA-TATE, is a radiopharmaceutical used in peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumors (NETs) 2.
- It is a synthetic somatostatin analogue that binds to somatostatin receptors (SSTRs) on the surface of NET cells, allowing for targeted delivery of radiation therapy.
Liver Metastases in Neuroendocrine Tumors
- Liver metastases are a common complication of neuroendocrine tumors, with the liver being the most common site of metastases for gastro-enteropancreatic NETs 3.
- The management of liver metastases in NET patients is complex and requires a multidisciplinary approach, including surgical, loco-regional, and systemic therapies 4, 3.
- Treatment options for liver metastases in NET patients include:
- Surgical resection
- Liver-directed therapies such as transarterial embolization, chemoembolization, and radioembolization
- Peptide receptor radionuclide therapy (PRRT) with radiopharmaceuticals like Dotatate
- Systemic therapies such as somatostatin analogs and chemotherapy
Efficacy of Dotatate in Treating Liver Metastases
- Studies have shown that PRRT with Dotatate is effective in treating liver metastases in NET patients, with improvements in progression-free survival and overall survival 2, 5.
- However, the efficacy of Dotatate may be influenced by factors such as the burden of liver metastases, with higher burdens associated with shorter progression-free survival 5.