Peptide Receptor Radionuclide Therapy in Advanced Refractory Meningiomas: Efficacy and Toxicity in a Long Follow-up.

in Journal of nuclear medicine : official publication, Society of Nuclear Medicine by Stefano Severi, Ilaria Grassi, Alberto Bongiovanni, Silvia Nicolini, Irene Marini, Donatella Arpa, Nicoletta Ranallo, Irene Azzali, Valentina Di Iorio, Anna Sarnelli, Monti Manuela, Elena Amadori, Lucia Fabbri, Daniela Bartolini, Luigino Tosatto, Francesco Di Meco, Lorena Gurrieri, Nada Riva, Luana Calabro, Federica Matteucci, Giovanni Paganelli, Maddalena Sansovini

TLDR

  • PRRT with Y-DOTATOC or Lu-DOTATATE shows a 57% disease control rate and is a potential active therapy option for recurrent meningiomas overexpressing somatostatin receptor 2.

Abstract

Recurrence of meningiomas after surgery and radiotherapy deserves specific attention because of the lack of active third-line therapies. Somatostatin receptors are usually overexpressed on the cell membrane of meningiomas, and this has led the way to a radionuclide theranostic approach. Diagnoses withGa-DOTA-octreotide and peptide receptor radionuclide therapy (PRRT) withY/Lu-DOTA-octreotide are currently possible options within experimental protocols or as compassionate use in small patient groups.From October 2009 to October 2021, 42 meningioma patients with radiologic recurrence after standard therapies were treated withY-DOTATOC (dosage of 1.1 or 5.5 GBq) or withLu-DOTATATE (dosage of 3.7 or 5.5 GBq) in a mean of 4 cycles. All patients showed intense uptake at diagnosticGa-DOTATOC PET/CT or in anIn-octreotide scan.Of 42 patients treated, 5 patients receivedY-DOTATOC with a cumulative activity of 11.1 GBq and 37 patients receivedLu-DOTATATE with a cumulative activity of 22 GBq. The disease control rate was 57%. With a median follow-up of 63 mo, median progression-free survival was 16 mo, and median overall survival was 36 mo. RetreatmentLu-PRRT was performed in 6 patients with an administered median activity of 13 GBq in a mean of 5 cycles. With a 75.8-mo follow-up, median progression-free survival and overall survival were 6.5 and 17 mo, respectively. Only 1 patient discontinued the treatment because of grade 3 platelet toxicity. A rapidly transient grade 2 neutropenia was recorded in 1 retreated patient.PRRT in patients with advanced meningiomas overexpressing somatostatin receptor 2 was active and well tolerated, showing a 57% disease control rate. Furthermore, PRRT could represent a potential retreatment option. Further studies, also in combination with other treatments, are warranted.

Overview

  • The study aimed to investigate the efficacy and tolerance of peptide receptor radionuclide therapy (PRRT) with Y-DOTATOC or Lu-DOTATATE in patients with recurrent meningiomas.
  • The study included 42 patients with radiologic recurrence after standard therapies who received PRRT with a median of 4 cycles.
  • The primary objective was to evaluate the disease control rate, progression-free survival, and overall survival in patients with advanced meningiomas overexpressing somatostatin receptor 2.

Comparative Analysis & Findings

  • The disease control rate was 57%, with median progression-free survival of 16 months and median overall survival of 36 months.
  • Retreatment with Lu-PRRT showed median progression-free survival and overall survival of 6.5 and 17 months, respectively.
  • The treatment was well tolerated, with only 1 patient experiencing grade 3 platelet toxicity and 1 patient experiencing a rapidly transient grade 2 neutropenia.

Implications and Future Directions

  • PRRT with Y-DOTATOC or Lu-DOTATATE represents a potential active therapy option for patients with recurrent meningiomas overexpressing somatostatin receptor 2.
  • Further studies are warranted to investigate the combination of PRRT with other treatments and its efficacy in larger patient cohorts.
  • The potential for retreatment with PRRT in cases of relapse or progression also needs further evaluation.
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