Endocrine Abstracts

Neuroendocrine neoplasms (NENs) arise from specialized cells called neuroendocrine cells spread through the body, mainly in the gastrointestinal tract, pancreas and lung. Pathological classification of Lung NENs include well differentiated NENs, that can be classified as typical or atypical carcinoids, and poorly differentiated neuroendocrine carcinomas (NECs), classified as small-cell lung carcinoma (SC-NEC) or large-cell neuroendocrine carcinoma (LC-NEC). We present a case of a 59-year-old female patient, who was referred to our hospital in 2012, for treatment with Peptide Receptor Radionuclide Therapy (PRRT) with ¹⁷⁷Lu-DOTATATE, due to progressive metastatic NEN lung disease. The patient had previously been submitted to primary tumour ressection, in 1999, with histopathological diagnosis of an atypical lung carcinoid. Due to metastasis in liver (2008), bone (2009) and kidney (2012), the patient underwent various treatments, namely somatostatin analogues (2008); chemotherapy (may 2008-June 2009); anti-algic radiotherapy (2009) and sunitinib (July 2009-february 2012). She was referred to IPO Porto, due disease progression despite multiple treatments. As she had high expression of somatostatin receptors on ⁶⁸Ga-DOTA-NOC-PET/CT, the patient underwent 3 cycles of PRRT treatments from 2012 to 2013 (Before NETTER-1 results). A dose adjustment in the administered activity was made, due to higher treatment toxicity risk of the patient, given her clinical background of chronic kidney disease (GFR ~48 ml/min). Despite the reduced treatment activity (total: 14.99 GBq), treatment response was obtained (imaging improvement, with visualization of fewer foci of ⁶⁸Ga-DOTANOC PET/CT uptake at liver and bone level). No renal or hematological toxicity occurred. Disease progression was diagnosed in ⁶⁸Ga-DOTANOC PET/CT in may 2016, with new bone and hepatic lesion detected however not detectable by CT imaging. After 10 years, the patient remains clinically stable, under treatment with cold somatostatin analogues. Despite PRRT with ¹⁷⁷Lu-DOTATATE not being yet approved by the EMA for treatment of lung NETs, this case illustrates the potential clinical benefit of this treatment in this group of patients. Besides, chronic kidney disease (CKD) patients should have individualized approach as they can benefict from PRRT at lower doses, with clinical and imagiological response. Randomized clinical studies are needed to validate PRRT in lung NENs.