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Long-Term Follow-Up of Renal Function After Peptide Receptor Radiation Therapy with ⁹⁰Y-DOTA⁰,Tyr³-Octreotide and ¹⁷⁷Lu-DOTA⁰, Tyr³-Octreotate

¹ Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
² Service de Medecine Nucleaire, Cliniques Universitaires Saint-Luc, Universite Catholique Louvain, Brussels, Belgium
³ Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Hospital, University of South Florida, Tampa, Florida
⁴ Novartis Pharmaceuticals Corp., East Hanover, New Jersey

View larger version (9K): [in a new window]   FIGURE 1. Time course of CLR and fitted monoexponential decay. (A) Patient was 75-y-old woman with insulinoma and hypertension who received 11.6 GBq of 90Y-DOTATOC, with estimated renal dose of 27.5 Gy. CLR loss was 26%/y (95% CI, 24.4%–27.5%), with ESRD at 5 y after first treatment. (B) Patient was 52-y-old man with papillary thyroid carcinoma who received 25.9 GBq of 177Lu-DOTATATE, with estimated renal dose of 23.3 Gy. CLR loss was 2.7%/y (95% CI, 0.2%–5.0%).

View larger version (9K): [in a new window]   FIGURE 2. Comparison of decline in CLR in 28 patients treated with 90Y-DOTATOC (A) and 37 patients treated with 177Lu-DOTATATE (B). Especially with 177Lu-DOTATATE, most patients have CLR loss <5%/y (normal age-related CLR loss is 1%/y). Only patients with CLR loss >25%/y are expected to develop ESRD within 5 y.

View larger version (12K): [in a new window]   FIGURE 3. (A) Yearly loss in CLR >20% (black bars) and <20% (white bars) in 28 patients treated with 90Y-DOTATOC who had 0–4 risk factors from hypertension, diabetes, age >60 y, and maximal per-cycle renal radiation dose >14 Gy. (B) Yearly loss in CLR >20% and <20% in 65 patients treated with 90Y-DOTATOC or 177Lu-DOTATATE who had 0–5 risk factors from hypertension, diabetes, age >60 y, cumulative renal radiation dose, and maximal per cycle radiation dose.

View larger version (41K): [in a new window]   FIGURE 4. Coronal SPECT images 24 h after injection of 220 MBq 111In-DTPA-octreotide in the same patient at separate occasions. (B) Study was performed with coinfusion of lysine 25 g + arginine 25 g in 1,000 mL, with 40% reduction of renal activity compared with the control investigation (8).