Therapy with 177Lu marked somatostatin analogues in a case of pancreatic metastatic neuroendocrine tumor

Sandra Belo; Ines Lucena; Ana Paula Santos; Luis Pedro Afonso; Cristina Sanches; Hugo Duarte

doi:10.1530/endoabs.32.P568

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Endocrine Abstracts (2013) 32 P568 | DOI: 10.1530/endoabs.32.P568

ECE2013 Poster Presentations Endocrine tumours and neoplasia (66 abstracts)

Therapy with ¹⁷⁷Lu marked somatostatin analogues in a case of pancreatic metastatic neuroendocrine tumor

Sandra Belo ^1, , Ines Lucena ² , Ana Paula Santos ³ , Luis Pedro Afonso ⁴ , Cristina Sanches ⁵ & Hugo Duarte ²

Err

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¹Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João, Porto, Portugal; ²Department of Nuclear Medicine, Instituto Portugues de Oncologia, Porto, Portugal; ³Department of Endocrinology, Instituto Portugues de Oncologia, Porto, Portugal; ⁴Department of Pathology, Instituto Portugues de Oncologia, Porto, Portugal; ⁵Department of Neuroendocrine Surgery, Instituto Portugues de Oncologia, Porto, Portugal; ⁶Faculty of Medicine, University of Porto, Porto, Portugal.

Introduction: Conventional systemic therapies have limited role in metastasized neuroendocrine tumors (NET). Therefore an increasing role is attributed to ¹⁷⁷Lu labeled somatostatin analogues (SA).

Case: Man, 52 years, referred because of NET, diagnosed following liver biopsy for hepatic nodules (liver tissue infiltrated by NET, compatible with metastases). Endoscopic ultrasound revealed pancreatic nodular formation, 40×24 mm; ⁹⁹mTc scintigraphy revealed foci of hyperfixation in the liver, midline abdominal projection and left kidney upper pole. Serotonin levels were 183.0 ng/ml (40–450), A5HI 3.7 ng/24 h (2.0–10), chromogranin A (CgA) 286 ng/ml (<134), gastrin 118 ng/ml (<108), insulin 6.43 μUI/ml (6–30) and glucagon 472 pg/ml (100–190). Patient underwent body-caudal pancreatectomy. Histology revealed well differentiated pancreatic NET, G2, 2–10 mitoses/HFA, Ki67 3–20%, peri-pancreatic soft tissue, lymphovascular and perineural invasion, lymph nodes metastasis, positivity for Cam52, CgA, synaptophysin and NES. ⁶⁸Ga-DOTANOC-PET revealed liver, lumbo-aortic, periceliac lymph nodes foci of hyperfixation. Embolization of liver metastases and SA treatment was started. Second ⁶⁸Ga-DOTANOC-PET revealed new hepatic foci. Because of disease progression therapy with ¹⁷⁷Lu-DOTATATE was preformed. ⁶⁸Ga-DOTANOC-PET after three cycles of ¹⁷⁷Lu revealed fewer liver foci and no evidence of adenopathy.

Conclusion: Treatment with radiolabelled SA is a promising strategy in patients with inoperable or metastatic NET.