Intraarterial Administration of Peptide Receptor Radionuclide Therapy in Patients with Advanced Meningioma: Initial Safety and Efficacy

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FIGURE 1.
Example of patient 3 with meningioma of unknown grade undergoing intraarterial PRRT with [¹⁷⁷Lu]Lu-HA-DOTATATE. (A) Transaxial slices of baseline PET, contrast-enhanced (CE) T1-weighted MRI, and fused PET/MRI demonstrate SSTR-expressing meningioma in left cavernous sinus (white and black arrows). After 4 cycles of PRRT (posttherapeutic SPECT/CT imaging after the first cycle presented in B), complete remission according to RANO as well as PET criteria was recorded (C). In line with imaging, patient reported significant improvement of previous vertigo, headaches, and isolated unilateral abducens nerve palsy. Scale bars denote SUVs.

TABLE 1.

Patient Characteristics^*

Patient	Age^† (y)	Sex	Localization of tumor	CNS WHO grading	Previous therapy	Time interval^‡ (y)	Follow-up time (mo)
1	46	Female	Sphenoorbital (right hemisphere)	1	Surgery	7	43
2	78	Male	Parafalcine parietooccipital (right hemisphere)	2	Surgery/radiation	16	40
3	59	Female	Cavernous sinus (left hemisphere)	—	Radiation	4	38
4	95	Female	Posterior cranial fossa (right hemisphere)	—	None	9	34
5	77	Male	Parietal (right hemisphere)	—	None	1.5	14
6	73	Male	Parafalcine biparietal	2	Surgery/radiation	8	27
7	52	Male	Sphenoid wing (right hemisphere)	1	Surgery	10.5	24
8	64	Female	Frontal, temporooccipital and sphenoorbital (left hemisphere)	2–3^¶	Surgery/radiation	3.5	8
9	52	Male	Frontobasal expanding to para-/sellar region (both hemispheres)	1	Surgery	17	24
10	60	Female	Sphenoid wing (right hemisphere)	—	None	0.5	18
11	55	Female	Posterior cranial fossa (left hemisphere)	1	Surgery	9	14
12	74	Female	Parafalcine parietal (right hemisphere)	—	None	2	13
13	67	Female	Multiple intracranial locations (meningiomatosis; both hemispheres)	2	Surgery/radiation	20	1

↵* Patient 5 passed away from unknown cause 11 mo after second treatment cycle; patient 8 passed away from progressive disease 4 mo after third treatment cycle; patient 13 passed away from heart failure 1 mo after first treatment cycle.
↵† Age at first PRRT cycle.
↵‡ From primary diagnosis to PRRT.
↵¶ Histologically confirmed increasing dedifferentiation to CNS WHO grade 3 meningioma.

TABLE 2.

Outcome Including Imaging, Clinical Symptoms, and PFS

Patient	CNS WHO grading	Outcome		PFS (mo)	Cumulative number of cycles	Cumulative activity (GBq)
Patient	CNS WHO grading	Imaging	Clinical symptoms	PFS (mo)	Cumulative number of cycles	Cumulative activity (GBq)
1	1	Stable disease	Stable	41	4*	29.8
2	2	Stable disease after PRRT (complete remission after another tumor resection surgery)	Progressive frailty	4	4*	29.9
3	—	Complete remission	Improvement	38^†	4*	30.0
4	—	Stable disease	Stable	34^†	4*	28.3
5	—	—	Lost to follow-up	14	2*	14.9
6	2	Partial remission	Stable	27^†	4*	29.7
7	1	Stable disease	Stable	24^†	4*	29.8
8	2–3^‡	—	Clinical progression	4	3	22.3
9	1	Stable disease	Improvement	24^†	4	29.9
10	—	Stable disease	Stable	18^†	4*	30.1
11	1	Stable disease	Stable	14^†	4*	29.6
12	—	Stable disease	Stable	13^†	3*	22.4
13	2	—	Death	1	1	7.5

* Patients who received an embolization of tumor-feeding artery during last treatment cycle.
↵† Not reached at time point of censoring.
↵‡ Histologically confirmed increasing dedifferentiation to CNS WHO grade 3 meningioma.