Efficacy and Safety of Peptide Receptor Radionuclide Therapy with/without Capcitabine in Asymptomatic Rectal Neuronedocrine Tumour: Malaysian Initial Experience — ASN Events
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  3. Efficacy and Safety of Peptide Receptor Radionuclide Therapy with/without Capcitabine in Asymptomatic Rectal Neuronedocrine Tumour: Malaysian Initial Experience

Efficacy and Safety of Peptide Receptor Radionuclide Therapy with/without Capcitabine in Asymptomatic Rectal Neuronedocrine Tumour: Malaysian Initial Experience (#65)

TEIK HIN TAN 1 , BOON NANG LEE 1 , CHING YEEN BOEY 1
  1. National Cancer Institute, Putrajaya, PUTRAJAYA, Malaysia

Background:

Rectal Neuroendocrine Tumour (NET) is common in Asian population. Most patients are asymptomatic. Extensive metastases with occasional atypical site involvement is common in this group of patients. Here, we present 4 cases of our initial experience of treating this group of patients using peptide receptor radionuclide therapy (PRRT) or chemoradionuclide Therapy (PRCRT).

 

Methods:

177Lu-DOTATATE(LuTate) was used in the treatment with mean activity of 7.42+GBq/cycle. Dual tracer PET/CT imaging using 68Ga-DOTATATE(GaTate) and 18F-FDG was performed prior therapy. Three patients demonstrated concomitant de-differentiated lesions. During therapy, all patients received Arginin/Lysin 25 mg, Odansetron 8mg, Dexamethasone 4mg and Esomeperazole 40mg. Two patients received capcitabine as radiosensitizer.  Dosimetry was performed during the first cycle. Response was assessed by GaTate at 6-week after  2nd cycles; and dual tracer imaging at 3-4 months  after 4th cycle. Adverse event was assessed by using CTCAE.

 

Results:

Four asymptomatic rectal NET patients (mean age: 55 years) showed normal CgA but demonstrable disease progression on GaTate when on long-acting sandostatin. All patients demonstrated extensive liver and bone metastases with additional extra-orbital metastasis seen in 2 patients. Remarkable response was seen during (at 2nd cyle) and after  (4th cycle) of treatment. One patient who received 4-cycle of PRCRT, demonstrated complete response with resolution of uptake on dual-tracer imaging. One patient only received 2-cycle of PRRT due to favourable response at 6-week after 2nd cycle.

 

Three patients developed Grade 1 gastritis and vomiting on 1st cycle. Since commencing esomeprazole, no documented gastritis/vomiting seen in subsequent treatment. Grade 3 transient haematological toxicity was noted in 1 patient, whereas Grade 1 in 3 patients. No transfusion required.

 

Conclusion:

PRRT/ PRCRT is an efficient and tolerable treatment in asymptomatic patients with extensive metastatic rectal NET. Esomeprazole may help in reducing GI toxicity.