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Research ArticleTheranostics
Open Access

Addition of 131I-MIBG to PRRT (90Y-DOTATOC) for Personalized Treatment of Selected Patients with Neuroendocrine Tumors

David L. Bushnell, Kellie L. Bodeker, Thomas M. O’Dorisio, Mark T. Madsen, Yusuf Menda, Stephen Graves, Gideon K.D. Zamba and M. Sue O’Dorisio
Journal of Nuclear Medicine September 2021, 62 (9) 1274-1277; DOI: https://doi.org/10.2967/jnumed.120.254987
David L. Bushnell
1Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa;
2Iowa City Virginia Healthcare System, Iowa City, Iowa;
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Kellie L. Bodeker
1Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa;
3Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa;
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Thomas M. O’Dorisio
4Division of Endocrinology, Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa;
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Mark T. Madsen
1Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa;
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Yusuf Menda
1Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa;
2Iowa City Virginia Healthcare System, Iowa City, Iowa;
3Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa;
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Stephen Graves
1Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa;
3Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa;
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Gideon K.D. Zamba
5Department of Biostatistics, University of Iowa Hospital and Clinics, Iowa City, Iowa; and
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M. Sue O’Dorisio
6Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa
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  • FIGURE 1.
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    FIGURE 1.

    Trial design. DLT = dose-limiting toxicities.

  • FIGURE 2.
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    FIGURE 2.

    Subject 1. (A) 111In-pentetreotide axial SPECT image through mid liver demonstrating multiple octreopeptide-positive metastases with focal intense uptake in target lesion (arrow). (B) 131I-MIBG SPECT axial slice at same level demonstrating intense uptake in same lesion (arrow). (C) Corresponding baseline venous phase CT scan depicting multiple liver metastases consistent with SPECT findings. Target lesion is 35.5 mm in maximum diameter. (D) Follow-up CT 6-mo after cycle 2 showing measurement of target lesion (maximum diameter, 26.4 mm).

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    FIGURE 3.

    Modified trial design. AA = administered activity; DOTATE = DOTATATE; SOC = standard of care.

Tables

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    TABLE 1

    Calculated Administered Activity Levels to Achieve Dose Limit of 1,900 cGy to Kidneys Plus 150 cGy to Bone Marrow

    Maximum total activity 90Y-DOTATOC plus 131I-MIBG (GBq)
    Subject no.Maximum total activity 90Y-DOTATOC only (GBq)90Y-DOTATOC131I-MIBG
    110.88.711.4
    27.85.618.3
    35.02.818.7
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    TABLE 2

    Posttreatment Renal and Bone Marrow Toxicity Assessment

    Cycle 1Cycle 2
    ParameterBaseline1 mo2 mo1 mo2 mo6 mo
    Creatinine (mg/dL)
     Subject 11.201.11.101.301.101.60
     Subject 21.100.860.940.981.131.00
     Subject 31.101.140.951.001.071.10
    Platelet (k/mm3)
     Subject 1396151215191216165
     Subject 21878212886130189
     Subject 325310715011147173
    Absolute neutrophil count (cells/mm3)
     Subject 15,0506,5104,3105,6304,5604,100
     Subject 26,5104,5003,8004,1004,8005,180
     Subject 33,2303,3931,5753,2811,3323,520
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Journal of Nuclear Medicine: 62 (9)
Journal of Nuclear Medicine
Vol. 62, Issue 9
September 1, 2021
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Addition of 131I-MIBG to PRRT (90Y-DOTATOC) for Personalized Treatment of Selected Patients with Neuroendocrine Tumors
David L. Bushnell, Kellie L. Bodeker, Thomas M. O’Dorisio, Mark T. Madsen, Yusuf Menda, Stephen Graves, Gideon K.D. Zamba, M. Sue O’Dorisio
Journal of Nuclear Medicine Sep 2021, 62 (9) 1274-1277; DOI: 10.2967/jnumed.120.254987

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Addition of 131I-MIBG to PRRT (90Y-DOTATOC) for Personalized Treatment of Selected Patients with Neuroendocrine Tumors
David L. Bushnell, Kellie L. Bodeker, Thomas M. O’Dorisio, Mark T. Madsen, Yusuf Menda, Stephen Graves, Gideon K.D. Zamba, M. Sue O’Dorisio
Journal of Nuclear Medicine Sep 2021, 62 (9) 1274-1277; DOI: 10.2967/jnumed.120.254987
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Keywords

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