Metastatic Medullary Thyroid Cancer: The Role of 68Gallium-DOTA-Somatostatin Analogue PET/CT and Peptide Receptor Radionuclide Therapy.

Abstract

CONTEXT:

Metastatic medullary thyroid cancer (MTC) is a rare malignancy with minimal treatment options. Many, but not all, MTCs express somatostatin receptors.

OBJECTIVE:

Our aim was to explore the role of 68Ga-DOTA-somatostatin analogue (SSA) positron emission tomography (PET)/computed tomography (CT) in patients with metastatic MTC and to determine their eligibility for peptide receptor radionuclide therapy (PRRT).

METHODS:

We retrospectively identified patients with metastatic MTC who had 68Ga-DOTA-SSA PET/CT at 5 centers. We collected characteristics on contrast-enhanced CT, 68Ga-DOTA-SSA and 18F-FDG PET/CT. The efficacy of PRRT was explored in a subgroup of patients. Kaplan-Meier analysis was used to estimate time to treatment failure (TTF) and overall survival (OS).

RESULTS:

Seventy-one patients were included (10 local recurrence, 61 distant disease). Of the patients with distant disease, 16 (26%) had ≥50% of disease sites with tracer avidity greater than background liver, including 10 (10/61, 16%) with >90%. In 19 patients with contemporaneous contrast-enhanced CT, no disease regions were independently identified on 68Ga-DOTA-SSA PET/CT. Thirty-five patients had an 18F-FDG PET/CT, with 18F-FDG positive/68Ga-DOTA-SSA negative metastases identified in 15 (43%). Twenty-one patients had PRRT with a median TTF of 14 months (95% CI 8-25) and a median OS of 63 months (95% CI 21-not reached). Of the entire cohort, the median OS was 323 months (95% CI 152-not reached). Predictors of poorer OS included a short calcitonin doubling-time (≤24 months), strong 18F-FDG avidity, and age ≥60 years.

CONCLUSIONS:

The prevalence of high tumor avidity on 68Ga-DOTA-SSA PET/CT is low in the setting of metastatic MTC; nevertheless, PRRT may still be a viable treatment option in select patients.

• Authors: Aimee R Hayes, Alexander Crawford, Khulood Al Riyami, Christine Tang, Jamshed Bomanji, Stephanie E Baldeweg, Damian Wild, Daniel Morganstein, Alice Harry, Simona Grozinsky-Glasberg, Kira Oleinikov, Bernard Khoo, Martyn E Caplin, Guillaume P Nicolas, Ashley B Grossman
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 106 Issue 12 Pg. e4903-e4916 (11 19 2021) ISSN: 1945-7197 [Electronic] United States
• PMID: 34379772 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Organometallic Compounds
• Receptors, Peptide
• Receptors, Somatostatin
• Somatostatin
• gallium Ga 68 dotatate

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Neuroendocrine (diagnostic imaging, radiotherapy, secondary)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Organometallic Compounds (therapeutic use)
• Positron Emission Tomography Computed Tomography (methods)
• Prognosis
• Receptors, Peptide (therapeutic use)
• Receptors, Somatostatin (therapeutic use)
• Retrospective Studies
• Somatostatin (chemistry)
• Survival Rate
• Thyroid Neoplasms (diagnostic imaging, radiotherapy, secondary)
• Young Adult