ECE2019 Poster Presentations Adrenal and Neuroendocrine Tumours 3 (70 abstracts)
(131) I-MIBG therapy in metastatic paraganglioma and phaeochromocytoma: a 4-year single centre experience
Estefanía Santos Mazo 1 , Isabel Lanchas 2 , Miguel Begoña 2 , Javier Pi Barrio 1 , Guillermo Crespo 3 , Manuela Moreira 4 , Victor García-Hierro 1 & Javier Sánchez Manuel 5
1Endocrinology and Nutrition (University Hospital), Burgos, Spain; 2Nuclear Medicine (University Hospital), Burgos, Spain; 3Oncology (University Hospital), Burgos, Spain; 4Endocrinology and Nutrition (University Hospital), Palencia, Spain; 5Surgery (University Hospital), Burgos, Spain.
Retrospective study of patients with metastatic/progressive pheochromocytoma (PCC) and paraganglioma (PGL) treated with (131) I MIBG in our hospital during 2015–2018 period.
Methods: There are no established criteria for establishing PCC/PGL as malignant apart from de presence of metastases at diagnosis. Radionuclide therapy (131) I-metaiodobenzylguanidine (MIBG) is frequently used in this patients when surgery is not possible. Indication of MIBG treatment was made in the Neuroendocrine Tumor Multidisciplinary Team meeting. After a (123) I-MIBG to assess tracer uptake standard 200 mCi (131) I-MIBG dose was administered in each patient until disease stabilization and then follow up was made.
Results:
| Paciente A | Paciente B | Paciente C | |
| Diagnosis | PGL stage IV | PCC stage IV | PCC stage IV |
| Metastases at diagnosis | liver, bone, peritoneum, mesenteric lymph nodes | Lung | Diaphragm, liver, periadrenalectomy tissue, para aortic lymph node |
| Age | 58 | 58 | 57 |
| Sex | Female | Female | Male |
| Genetic testing | Negative | Negative | Negative |
| Ki 67 | 1% | - | - |
| Clinically functioning tumor | Mild hypertension Flushing | Bad controlled hypertension | Bad controlled hypertension |
| Other treatments before I-MIBG | Surgery 2009-2013 Temodal+Capecitabine 2015 (neutropenia) | Surgery 1980 | Surgery 2004 |
| Treatment cycles | 4 (Jan 2016-March 2017) | 4 (Sept 2015-Jan 2017) | 4 (Nov 2013-2014)+4 (Feb 2018-August 2018) |
| Before treatment Plasma Normetanephrine (N<180 pg/ml) Urine Normetanephirne (N<444 ug/24h) | January 2016 -Plasma Normetanephrine 199 pg/ml -Urine Normetanephrine 1122 ug/24 | September 2015 -Plasma Normetanephrine 300 pg/ml -Urine Normetanephrine 1192ug/24 h | 2013 -Plasma Normetanephrine 788 (<444) |
| After last MIBG treatment (hormonal response) | October 2018 -Plasma Normetanephrine 158 pg/ml -Urine Normetanephrine 614 ug/24 h | November 2018 -Plasma Normetanephrine 2 213 pg/ml -Urine Normetanephrine 631 ug/24 h | - |
| Clinical Response to treatment | Less frequent and intense hot flashes Well controlled hypertension | Well controlled hypertension | Better control of hypertension |
| Radiological response (RECIST) to treatment | Stable disease | Stable disease | Progression liver metastases in 2014 Stable disease 2018 |
| Metabolic response to treatment | Stabilization or mild response in liver and mesentery. Metabolic response in bone | Stabilization or partial response (lung) | Partial metabolic response in liver Stabilization para aortic lymph node |
| Free Progression Survival | +36 months | +40 months | +45 months |
| Cumulative activity (MBq) | 800 mCi | 800 mCi | 1550 mCi |
| Haematological toxicity | None | Neutropenia grade2 | None |
| Renal toxicity | None | None | None |
Conclusion: Therapy with (131) I-MIBG is a safe therapeutical option in patients with metastatic PCC/PGL, leading to easier control of hypertension, and mild improvement or at least stabilization of disease progression without major side effects in our 4 year centre experience.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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