PT - JOURNAL ARTICLE AU - Lamiaa Zidan AU - Amir Iravani AU - Kira Oleinikov AU - Simona Ben-Haim AU - David J. Gross AU - Amichay Meirovitz AU - Ophra Maimon AU - Tim Akhurst AU - Michael Michael AU - Rodney J. Hicks AU - Simona Grozinsky-Glasberg AU - Grace Kong TI - Efficacy and Safety of <sup>177</sup>Lu-DOTATATE in Lung Neuroendocrine Tumors: A Bicenter study AID - 10.2967/jnumed.120.260760 DP - 2022 Feb 01 TA - Journal of Nuclear Medicine PG - 218--225 VI - 63 IP - 2 4099 - http://jnm.snmjournals.org/content/63/2/218.short 4100 - http://jnm.snmjournals.org/content/63/2/218.full SO - J Nucl Med2022 Feb 01; 63 AB - The purpose of this study was to assess the efficacy and safety of 177Lu-DOTATATE in patients with somatostatin receptor (SSR)–positive lung neuroendocrine tumors (NETs). Methods: This is a retrospective review of the outcome of patients with typical carcinoid (TC) and atypical carcinoid (AC), treated with 177Lu-DOTATATE at 2 ENETS Centers of Excellence. Morphologic imaging (RECIST 1.1) and 68Ga-DOTATATE PET/CT responses were assessed at 3 mo after completion of 177Lu-DOTATATE. Concordance between 2 response assessment methods was evaluated by κ statistics. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan–Meier analysis and compared by Log-rank test. Treatment-related adverse events (AEs) were graded based on Common Terminology Criteria for Adverse Events, version 5. Results: Of 48 patients (median age, 63 y; 13 women), 43 (90%) had AC and 5 (10%) TC. Almost all patients (47, 98%) were treated due to progression. Most patients (40, 83%) received somatostatin analogs, and 10 patients (20%) had prior everolimus, chemotherapy, or both. All patients had high SSR expression (≥ modified Krenning score 3) on pretreatment 68Ga-DOTATATE PET/CT. Patients received a median 4 (range, 1–4) cycles of 177Lu-DOTATATE (33% with concurrent radiosensitizing chemotherapy) to a median cumulative activity of 27 GBq (range, 6–43GBq). At a median follow-up of 42 mo, the median PFS and OS were 23 mo (95% CI, 18–28 mo) and 59 mo (95% CI, 50-not reached [NR]), respectively. Of 40 patients with RECIST-measurable disease and 39 patients with available 68Ga-DOTATATE PET/CT, response categories were partial response, 20% (95% CI, 10%–35%) and 44% (95% CI, 30%–59%); stable disease, 68% (95% CI, 52%–80%) and 44% (95% CI, 30%–59%); and progressive disease, 12% (95% CI, 5%–27%) by both, respectively. There was a moderate concordance between response categories by RECIST and 68Ga-DOTATATE PET/CT, weighted κ of 0.51 (95% CI, 0.21–0.68). Of patients with stable disease by RECIST, those with partial response on 68Ga-DOTATATE PET/CT had a longer OS than those with no response, NR versus 52 mo (95% CI, 28–64), hazard ratio 0.2 (95% CI, 0.1–0.6), P &lt; 0.001. Most grade 3/4 AEs were reversible and the most common was lymphopenia (14%) with no incidence of myelodysplasia or leukemia. Conclusion: In patients with advanced progressive lung NET and satisfactory SSR expression, 177Lu-DOTATATE is effective and safe with a high disease control rate and encouraging PFS and OS.