Article Figures & Data
Figures
- FIGURE 1.
Percentage change in summed longest diameter of target lesions per RECIST 1.1 criteria. Over course of planned follow-up period (24 wk), 2 patients met criteria for progressive disease. Over longer optional 1-y follow-up period, 1 additional patient met criteria for progressive disease. No patients met criteria for partial response during follow-up period. Two patients who ultimately died had identical changes in summed longest diameter of their target lesions at 12 wk, after which both were lost to imaging follow-up (black line with red X). Black dotted lines = thresholds for progressive disease and partial response per RECIST 1.1 criteria; gray dotted line = planned follow-up period in study protocol. LD = longest diameter.
- FIGURE 2.
Ratio of median intraarterial-to-intravenous 68Ga-DOTATOC SUVmax for hepatic tumors, extrahepatic tumors, and uninvolved organs. There was trend toward statistical significance for difference in intraarterial-to-intravenous ratios between liver lesions and uninvolved organs (P = 0.063). IA = intraarterial; IV = intravenous.
- FIGURE 3.
(A) Change in median SUVmax for hepatic tumors, extrahepatic tumors, and uninvolved organs (spleen in 4 patients, left kidney in 1 asplenic patient) from intravenous administration of 68Ga-DOTATOC to intraarterial administration. There was trend toward statistical significance for difference between intravenous and intraarterial SUVmax in liver tumors (P = 0.063) and uninvolved organs (P = 0.063). (B) Change in median hepatic tumor SUVmax from intravenous administration of 68Ga-DOTATOC to intraarterial administration for each patient. Patients 1 and 5 had low hepatic tumor burden (<25% of liver parenchyma), patient 2 had moderate burden (25%–50%), and patients 3 and 4 had high burden (>50%–75%). (C) Change in median ratio of SUVmax for hepatic tumors compared with extrahepatic tumors from intravenous administration of 68Ga-DOTATOC to intraarterial administration. All extrahepatic tumors had decreased uptake with intraarterial compared with intravenous administration. Patient 1 did not have extrahepatic metastatic disease. IA = intraarterial; IV = intravenous.
- FIGURE 4.
Examples of changes in uptake with intravenous versus intraarterial administration of 68Ga-DOTATOC. (A) Maximum-intensity projections through abdomen in patient with high (50%–70%) degree of liver involvement, showing that uptake in hepatic metastases is slightly higher with intraarterial than intravenous administration. (B) Maximum-intensity projections through abdomen in patient with low (<25%) degree of liver involvement, showing that uptake in hepatic metastases is slightly lower with intraarterial than intravenous administration. For all patients, uninvolved-organ uptake decreased as expected on intraarterial administration (e.g., in spleen [*] and left kidney [**]). H = hepatic metastases; IA = intraarterial; IV = intravenous.
Tables
Characteristic Parameter Data Age at baseline scan (y) 69.8 (46–76) Sex Female 2 (20%) Male 8 (80%) Primary location Small bowel 4 (40%) Pancreas 3 (30%) Large bowel 1 (10%) Bronchial 1 (10%) Gastric 1 (10%) Liver involvement with metastatic disease <25% 3 (30%) 25%–50% 4 (40%) 51%–70% 3 (30%) Extrahepatic disease Yes 7 (70%) No 3 (30%) Metastatic locations Liver 10 (100%) Lung 1 (10%) Bone 3 (30%) Other 7 (70%) Previous treatments Surgery 6 (90%) SSA therapy 10 (100%) Chemotherapy 4 (40%) Targeted agents 2 (20%) Liver-directed TAE/TACE 3 (30%) 90Y-SIRT 2 (20%) Lines of prior therapy per patient 4 (1–6) Tumor grade 1 (Ki-67 < 3%) 4 (40%) 2 (Ki-67 = 3%–20%) 5 (50%) 3 (Ki-67 > 20%) 1 (10%) Administered dose of 90Y-DOTATOC mCi 95.95 (83.1–102.1) MBq 3,550 (3,074–3,778) TAE/TACE = transarterial embolization/transarterial chemoembolization; SIRT = selective internal radiation therapy.
Qualitative data are numbers followed by percentages in parentheses; continuous data are median followed by range in parentheses.
Adverse event Grade 1–2 Possible, probable, or definite attribution Grade 3 Possible, probable, or definite attribution Highest toxicity grade* 6 (60%) 6/6 (100%) 3 (30%) 0/3 (0%) Fatigue 8 (80%) 8/8 (100%) 0 (0%) NA Anorexia 2 (20%) 2/2 (100%) 0 (0%) NA Vomiting 2 (20%) 2/2 (100%) 0 (0%) NA Alkaline phosphatase increased 2 (20%) 2/2 (100%) 0 (0%) NA Hypoalbuminemia 2 (20%) 2/2 (100%) 0 (0%) NA Upper respiratory tract infection 2 (20%) 0/2 (0%) 0 (0%) NA Cholangitis 0 (0%) NA 1 (10%) 0/1 (0%) Hyponatremia 0 (0%) NA 1 (10%) 0/1 (0%) Pulmonary embolism 0 (0%) NA 1 (10%) 0/1 (0%) Urinary tract infection 0 (0%) NA 1 (10%) 0/1 (0%) Abdominal pain 1 (10%) 1/1 (100%) 0 (0%) NA Anemia (hemoglobin) 1 (10%) 1/1 (10%) 0 (0%) NA Blood total bilirubin increased 1 (10%) 1/1 (10%) 0 (0%) NA Diarrhea 1 (10%) 0/1 (0%) 0 (0%) NA Dysuria 1 (10%) 0/1 (0%) 0 (0%) NA Nausea 1 (10%) 1/1 (100%) 0 (0%) NA Platelet count decreased 1 (10%) 1/1 (100%) 0 (0%) NA Supraventricular tachycardia 1 (10%) 0/1 (0%) 0 (0%) NA ↵* Two of 10 patients died during study. Both deaths were deemed possibly attributable to treatment.
NA = not applicable.
Adverse events are according to CTCAE 4.0. Highest toxicity grade is highest toxicity grade each patient experienced during study. One patient did not experience any significant toxicity. There were no grade 4 adverse events. Data are numbers followed by percentages in parentheses.
