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Peptide receptor radionuclide therapy for aggressive atypical pituitary adenoma/carcinoma: variable clinical response in preliminary evaluation.

AbstractPURPOSE:
There are limited treatment options for progressive atypical pituitary adenomas and carcinomas. Peptide receptor radionuclide therapy that targets somatostatin receptors has recently been proposed as a potential treatment option. The theoretical rationale for efficacy is elegant but evaluation of outcomes in the first patients treated for this indication is required to assess whether further study is warranted.
METHODS:
We performed a case review of the three pituitary patients we have treated with (177)Lutetium DOTATATE in our institution (two atypical adenomas, one carcinoma) and dosimetric analysis of the radiation uptake in one patient.
RESULTS:
Treatment was well tolerated. One patient with slowly progressive pituitary carcinoma has stable disease 40 months after completing the planned 4 cycles of treatment. Two patients with rapidly progressive atypical adenomas terminated treatment early due to continued disease progression. Dosimetric evaluation revealed inhomogenous uptake across the tumour (1.3-11.9 Gy with one cycle).
CONCLUSION:
We have found mixed results in our first 3 patients with stable disease achieved only in the patient with the more slowly progressive tumour. As only a limited number of centres offer Peptide receptor radionuclide therapy, a formal study with prospective data collection may be feasible and if carried out should include dosimetric evaluation of absorbed dose.
AuthorsJillian Maclean, Matthew Aldridge, Jamshed Bomanji, Susan Short, Naomi Fersht
JournalPituitary (Pituitary) Vol. 17 Issue 6 Pg. 530-8 (Dec 2014) ISSN: 1573-7403 [Electronic] United States
PMID24323313 (Publication Type: Journal Article)
Chemical References
  • Organometallic Compounds
  • Radioisotopes
  • Radiopharmaceuticals
  • Receptors, Peptide
  • Lutetium
  • gallium Ga 68 dotatate
  • lutetium Lu 177 dotatate
  • Octreotide
Topics
  • Adult
  • Growth Hormone-Secreting Pituitary Adenoma (radiotherapy)
  • Humans
  • Lutetium
  • Male
  • Middle Aged
  • Octreotide (analogs & derivatives, therapeutic use)
  • Organometallic Compounds (therapeutic use)
  • Pituitary Neoplasms (radiotherapy)
  • Positron-Emission Tomography
  • Prolactinoma (radiotherapy)
  • Radioisotopes (therapeutic use)
  • Radiopharmaceuticals (therapeutic use)
  • Receptors, Peptide (metabolism)
  • Tomography, Emission-Computed, Single-Photon
  • Tomography, X-Ray Computed

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