Salvage Therapy with ¹⁷⁷Lu-Octreotate in Patients with Bronchial and Gastroenteropancreatic Neuroendocrine Tumors

Intrapatient comparison of changes in baseline characteristics from start of regular therapy to start of additional therapy with ¹⁷⁷Lu-octreotate. *P < 0.01 (sign test). ^†Not significant (sign test). ^‡Liver metastases not present with regular therapies developed in 4 patients (1 already very diffuse); extensive liver disease developed in 2 with limited lesions. SRS = somatostatin receptor scintigraphy.

Disease course in patient having carcinoid with liver metastases, presenting imaging studies, serum CgA levels, and body weight over time. Patient had severe diarrhea in 2001 with good clinical, scintigraphic, and radiologic responses after regular therapy with ¹⁷⁷Lu-octreotate in 2001. In March 2005, disease became progressive, but patient declined therapy. In December 2006, disease clearly progressed, and additional therapy with ¹⁷⁷Lu-octreotate was started. Patient again had partial remission and was still in remission 21 mo after additional therapy.

CgA levels in serum during course of disease. (A) Absolute CgA levels at various moments according to treatment outcome of additional therapy. (B) Relative levels of CgA, displaying change after regular therapy (ratio of nadir of CgA after regular therapy over CgA at start of regular therapy), before start of additional therapy (ratio of CgA at start of additional therapy over CgA at start of regular therapy), and after additional therapy (CgA level at follow-up after additional therapy over CgA at start of additional therapy). No change is indicated by 100%. Boxes show medians and 25th−75th percentiles; whiskers indicate ranges. Middle lines in boxes indicate medians. Add tx = additional therapy; MR = minor response; PD = progressive disease; PR = partial remission; Reg tx = regular therapy; SD = stable disease.