Peptide Receptor Radionuclide Therapy and clinical associations with renal and hematological toxicities and survival in patients with neuroendocrine tumors: an analysis from two U.S. medical centers

Tao Xu; Joseph S Dillon; Mary A Maluccio; Dawn E Quelle; Sarah H Nash; Hyunkeun Cho; Kristen E Limbach; Nicholas J Skill; Yvette Bren-Mattison; Michael A O’Rorke

doi:10.1007/s00432-024-06020-w

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Peptide Receptor Radionuclide Therapy and clinical associations with renal and hematological toxicities and survival in patients with neuroendocrine tumors: an analysis from two U.S. medical centers

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Peptide Receptor Radionuclide Therapy and clinical associations with renal and hematological toxicities and survival in patients with neuroendocrine tumors: an analysis from two U.S. medical centers

Tao Xu, Joseph S Dillon, Mary A Maluccio, Dawn E Quelle, Sarah H Nash, Hyunkeun Cho, Kristen E Limbach, Nicholas J Skill, Yvette Bren-Mattison and Michael A O’Rorke

Journal of cancer research and clinical oncology, Vol.150(11), 485

11/01/2024

DOI: 10.1007/s00432-024-06020-w

PMCID: PMC11531437

PMID: 39488644

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Abstract

PurposeRenal and hematological toxicity are side effects and dose-limiting factors of Peptide Receptor Radionuclide Therapy (PRRT). We aimed to assess the changes in renal and hematological function and associations with survival in neuroendocrine tumor (NET) patients treated with PRRT.MethodsA retrospective cohort of 448 NET patients treated with either 177Lu-DOTATATE or 90Y-DOTATOC were followed for changes of renal and hematological function. Renal function was assessed by monitoring changes in serum creatinine, blood urea nitrogen and estimated glomerular filtration rate. Hematological function was determined by examining changes in white blood cell counts (WBC), platelet counts, and hemoglobin levels over time. Piecewise linear mixed effect models were applied to model the longitudinal repeated measurements of renal and hematological function. Overall survival (OS) and progression-free survival (PFS) were modelled using Cox proportional hazard regressions.ResultsOf the 448 PRRT treated patients, 335 received 177Lu-DOTATATE (74.78%) and 113 were treated with 90Y-DOTATOC (25.22%). Comparing patients treated with 177Lu-DOTATATE to those treated with 90Y-DOTATOC, renal function did not differ significantly prior to, during or after PRRT. Compared with patients treated with 90Y-DOTATOC, significantly decreased indicators of hematological function were observed in those treated with 177Lu-DOTATATE prior to and during PRRT treatment (WBC: estimate, -0.10, 95% CI, -0.15 to -0.05; P < 0.001; platelet count: estimate, -2.53, 95% CI, -3.83 to -1.24; P < 0.001), and no significant recovery was observed in hematological function post PRRT. Individuals who received 177Lu-DOTATATE tended to have a longer PFS (hazard ratio, 0.47, 95%CI: 0.28–0.79, P = 0.004) compared with 90Y-DOTATOC, but there was no difference in OS.ConclusionThere was no significant renal, but minor hematological toxicity, in patients treated with 177Lu-DOTATATE compared with 90Y-DOTATOC. Compared to 90Y-DOTATOC, 177Lu-DOTATATE appears to enhance PFS, but not OS. Treatment with 177Lu-DOTATATE may necessitate follow-up for hematological toxicity irrespective of other therapies prior to PRRT.

Hematology

Peptides

Creatinine

Glomerular filtration rate

Hemoglobin

Leukocytes

Neuroendocrine system

Neuroendocrine tumors

Patients

Platelets

Radiation therapy

Renal function

Toxicity

Details

Title: Subtitle: Peptide Receptor Radionuclide Therapy and clinical associations with renal and hematological toxicities and survival in patients with neuroendocrine tumors: an analysis from two U.S. medical centers
Creators: Tao Xu - University of Iowa, Epidemiology
Joseph S Dillon - University of Iowa
Mary A Maluccio - Louisiana State University Health Sciences Center New Orleans
Dawn E Quelle - University of Iowa
Sarah H Nash - University of Iowa
Hyunkeun Cho - University of Iowa, Biostatistics
Kristen E Limbach - Tulane University
Nicholas J Skill - Louisiana State University Health Sciences Center New Orleans
Yvette Bren-Mattison - Louisiana State University Health Sciences Center New Orleans
Michael A O’Rorke - University of Iowa
Resource Type: Journal article
Publication Details: Journal of cancer research and clinical oncology, Vol.150(11), 485
DOI: 10.1007/s00432-024-06020-w
PMID: 39488644
PMCID: PMC11531437
NLM abbreviation: J Cancer Res Clin Oncol
ISSN: 0171-5216
eISSN: 1432-1335
Publisher: Springer Nature B.V
Grant note: National Center For Advancing Translational Sciences of the National Institutes of Health: UM1TR004403
The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. However, we would like to acknowledge that the research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UM1TR004403. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Language: English
Date published: 11/01/2024
Academic Unit: Epidemiology; Pathology; Biostatistics; Center for Social Science Innovation; Fraternal Order of Eagles Diabetes Research Center; Neuroscience and Pharmacology; Community and Behavioral Health; Endocrinology and Metabolism; Internal Medicine
Record Identifier: 9984740953602771

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