Article
177Lu-DOTATATE/90Y-DOTATOC peptide receptor radionuclide therapy in treatment refractory progressive meningioma
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Authors
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Veit M. Stoecklein
- Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Germany
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Michael Sommerauer
- Klinik für Nuklearmedizin, Universitätsspital Zürich, Switzerland
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Michael Weller
- Klinik für Neurologie, Universitätsspital Zürich, Switzerland
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Nathalie Albert
- Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München, Germany
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Jörg-Christian Tonn
- Neurochirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Germany
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Katharina Seystahl
- Klinik für Neurologie, Universitätsspital Zürich, Switzerland
| Published: | June 8, 2016 |
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Outline
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Objective: Meningioma is a usually benign disease with long-lasting tumor control after resection. However, in case of progression without option of further local therapy (such as re-resection or radiotherapy), the prognosis is grim. Up to now, there is no standard systemic therapy available. The vast majority of meningiomas express the somatostatin receptor IIA (SSTR-IIA). We here analyze whether systemic peptide receptor radionuclide therapy (PRRT) which targets the SSTR-IIA might be a promising salvage therapy.
Method: Patients from three centers were pooled for a retrospective analysis of PRRT with 177Lu-DOTATATE or 90Y-DOTATOC for treatment safety and efficacy. Individual lesions (n=89) were furthermore analyzed in order to correlate treatment response with pre-therapeutic standard uptake values (SUV) as SUVmean and SUVmax on 68Ga-DOTATOC/-TATE-PET/CT on a single-lesion level. Immunohistochemistry was used to stain the last available tumor tissue for SSTR-IIA.
Results: 20 patients (WHO grade I: n=5, II: n=7, III: n=8) were identified. Medium follow-up was 20 months. All patients had progressive disease prior to PRRT. 50% of patients achieved stable disease for a median of 17 months. Median progression-free survival (PFS) was 5.4 months for all patients. Stratification according to WHO grade showed a median PFS of 32.2 months for grade I tumors (7.2 for grade II, 2.1 for grade III). PFS at 6 months was 100% for grade I, 57% for grade II and 0% for grade III. Median overall survival (OS) was OS 17.2 months in WHO grade III patients and not reached for WHO I and II. 68Ga-DOTATOC/-TATE-PET/CT analysis showed that high pretherapeutic tracer uptake was correlated with longer PFS. SUVmax and SUVmean were significantly higher in lesions stable at 6 months as assessed by an individual analysis of single meningioma lesions (p<0.05). Immunohistochemistry demonstrated that high SSTR-IIA expression was associated with longer PFS. Side effects included reversible lymphocytopenia in 70% of patients and in single patients fatigue, alopecia, pituitary insufficiency and impaired wound healing.
Conclusions: PRRT is a safe therapy option in patients with progressive meningioma. Compared to historic benchmarks from the literature, PFS was superior in patients with grade I and II tumors, but not in WHO grade III tumors. Pretherapeutic 68Ga-DOTATOC/-TATE-PET/CT tracer uptake was associated with treatment response and might therefore help to tailor treatment.
