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Medullary Thyroid Carcinoma (MTC) Treated With 177 Lu-DOTATATE PRRT A Report of Two Cases William Makis, MD, Karey McCann, BScN, and Alexander J.B. McEwan, MD Abstract: Two patients diagnosed with metastatic medullary thyroid carcinoma (MTC) were referred for peptide receptor radionuclide therapy (PRRT) with 177 Lu-[DOTA0,Tyr3]octreotate (DOTATATE). Each patient was treated with 4 doses of 177Lu-DOTATATE given 2 months apart. One patient achieved stable disease for 10 months then chose to pursue surgery, and the other achieved stable disease for 9 months on imaging; however, calcitonin continued to rise. The use of 177Lu-DOTATATE PRRT therapy in the management of MTC warrants further research. Key Words: PRRT, 177Lu-DOTATATE, lutetium, medullary thyroid carcinoma, MTC, calcitonin, CEA, neuroendocrine tumor, NET (Clin Nucl Med 2015;40: 408–412)
Received for publication April 1, 2014; revision accepted December 10, 2014. From the Department of Diagnostic Imaging, Cross Cancer Institute, Edmonton, AB, Canada. Conflicts of interest and sources of funding: none declared. Reprints: William Makis, MD, Department of Diagnostic Imaging, Cross Cancer Institute, 11560 University Ave NW, Edmonton, AB, T6G 1Z2, Canada. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4005–0408
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REFERENCES 1. Diehl M, Risse JH, Brandt-Mainz K, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer: results of a multicentre study. Eur J Nucl Med. 2001;28:1671–1676. 2. Conry BG, Papathanasiou ND, Prakash V, et al. Comparison of (68)GaDOTATATE and (18)F-fluorodeoxyglucose PET/CT in the detection of recurrent medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2010;37:49–57. 3. Kauhanen S, Seppanen M, Ovaska J, et al. The clinical value of [18F]fluorodihydroxyphenylalanine positron emission tomography in primary diagnosis, staging, and restaging of neuroendocrine tumors. Endocr Relat Cancer. 2009;16: 255–265. 4. Scherubl H, Raue F, Ziegler R. Combination chemotherapy of advanced medullary and differentiated thyroid cancer. Phase II study. J Cancer Res Clin Oncol. 1990; 116:21–23. 5. Diez JJ, Iglesias P. Somatostatin analogs in the treatment of medullary thyroid carcinoma. J Endocrinol Invest. 2002;25:773–778. 6. Waldherr C, Schumacher T, Pless M, et al. Radiopeptide transmitted internal irradiation of non-iodophil thyroid cancer and conventionally untreatable medullary thyroid cancer using [90Y]-DOTA-D-Phe1-Tyr3-octreotide: a pilot study. Nucl Med Commun. 2001;22:673–678. 7. Iten F, Muller B, Schindler C, et al. Response to [90Yttrium-DOTA]-TOC treatment is associated with long-term survival benefit in metastasized medullary thyroid cancer: a phase II clinical trial. Clin Cancer Res. 2007;13:6696–6702. 8. Bodei L, Cremonesi M, Grana CM, et al. Peptide receptor radionuclide therapy with 177Lu-DOTATATE: the IEO phase I–II study. Eur J Nucl Med Mol Imaging. 2011;38:2125–2135. 9. Budiawan H, Salavati A, Kulkarni HR, et al. Peptide receptor radionuclide therapy of treatment-refractory metastatic thyroid cancer using (90)yttrium and (177)lutetium labeled somatostatin analogs: toxicity, response and survival analysis. Am J Nucl Med Mol Imaging. 2013;1:39–52.
Clinical Nuclear Medicine • Volume 40, Number 5, May 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 5, May 2015
MTC Treated With 177Lu-DOTATATE PRRT
FIGURE 1. A 75-year-old man, diagnosed with MTC on biopsy, had a total thyroidectomy with neck dissection, revealing a right-sided 2.8-cm tumor with 18/37 positive neck nodes levels 1–5 and 7. There was residual disease on 111In-octreotide scan and he was treated with 4 cycles of 177Lu-DOTATATE of 150 mCi each, given 2 months apart. A, Post-first 177Lu-DOTATATE treatment scan showed intensely avid right paratracheal nodes (up to 1.6 cm) and mildly avid left supraclavicular nodes (up to 1.0 cm). B, Post-fourth treatment scan showed stable disease. Calcitonin decreased from 11,565 ng/L before surgery to 2895 ng/L pre-first treatment and 2517 ng/L post-fourth treatment (normal
Medullary Thyroid Carcinoma (MTC) Treated With 177 Lu-DOTATATE PRRT A Report of Two Cases William Makis, MD, Karey McCann, BScN, and Alexander J.B. McEwan, MD Abstract: Two patients diagnosed with metastatic medullary thyroid carcinoma (MTC) were referred for peptide receptor radionuclide therapy (PRRT) with 177 Lu-[DOTA0,Tyr3]octreotate (DOTATATE). Each patient was treated with 4 doses of 177Lu-DOTATATE given 2 months apart. One patient achieved stable disease for 10 months then chose to pursue surgery, and the other achieved stable disease for 9 months on imaging; however, calcitonin continued to rise. The use of 177Lu-DOTATATE PRRT therapy in the management of MTC warrants further research. Key Words: PRRT, 177Lu-DOTATATE, lutetium, medullary thyroid carcinoma, MTC, calcitonin, CEA, neuroendocrine tumor, NET (Clin Nucl Med 2015;40: 408–412)
Received for publication April 1, 2014; revision accepted December 10, 2014. From the Department of Diagnostic Imaging, Cross Cancer Institute, Edmonton, AB, Canada. Conflicts of interest and sources of funding: none declared. Reprints: William Makis, MD, Department of Diagnostic Imaging, Cross Cancer Institute, 11560 University Ave NW, Edmonton, AB, T6G 1Z2, Canada. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4005–0408
408
www.nuclearmed.com
REFERENCES 1. Diehl M, Risse JH, Brandt-Mainz K, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer: results of a multicentre study. Eur J Nucl Med. 2001;28:1671–1676. 2. Conry BG, Papathanasiou ND, Prakash V, et al. Comparison of (68)GaDOTATATE and (18)F-fluorodeoxyglucose PET/CT in the detection of recurrent medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2010;37:49–57. 3. Kauhanen S, Seppanen M, Ovaska J, et al. The clinical value of [18F]fluorodihydroxyphenylalanine positron emission tomography in primary diagnosis, staging, and restaging of neuroendocrine tumors. Endocr Relat Cancer. 2009;16: 255–265. 4. Scherubl H, Raue F, Ziegler R. Combination chemotherapy of advanced medullary and differentiated thyroid cancer. Phase II study. J Cancer Res Clin Oncol. 1990; 116:21–23. 5. Diez JJ, Iglesias P. Somatostatin analogs in the treatment of medullary thyroid carcinoma. J Endocrinol Invest. 2002;25:773–778. 6. Waldherr C, Schumacher T, Pless M, et al. Radiopeptide transmitted internal irradiation of non-iodophil thyroid cancer and conventionally untreatable medullary thyroid cancer using [90Y]-DOTA-D-Phe1-Tyr3-octreotide: a pilot study. Nucl Med Commun. 2001;22:673–678. 7. Iten F, Muller B, Schindler C, et al. Response to [90Yttrium-DOTA]-TOC treatment is associated with long-term survival benefit in metastasized medullary thyroid cancer: a phase II clinical trial. Clin Cancer Res. 2007;13:6696–6702. 8. Bodei L, Cremonesi M, Grana CM, et al. Peptide receptor radionuclide therapy with 177Lu-DOTATATE: the IEO phase I–II study. Eur J Nucl Med Mol Imaging. 2011;38:2125–2135. 9. Budiawan H, Salavati A, Kulkarni HR, et al. Peptide receptor radionuclide therapy of treatment-refractory metastatic thyroid cancer using (90)yttrium and (177)lutetium labeled somatostatin analogs: toxicity, response and survival analysis. Am J Nucl Med Mol Imaging. 2013;1:39–52.
Clinical Nuclear Medicine • Volume 40, Number 5, May 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 5, May 2015
MTC Treated With 177Lu-DOTATATE PRRT
FIGURE 1. A 75-year-old man, diagnosed with MTC on biopsy, had a total thyroidectomy with neck dissection, revealing a right-sided 2.8-cm tumor with 18/37 positive neck nodes levels 1–5 and 7. There was residual disease on 111In-octreotide scan and he was treated with 4 cycles of 177Lu-DOTATATE of 150 mCi each, given 2 months apart. A, Post-first 177Lu-DOTATATE treatment scan showed intensely avid right paratracheal nodes (up to 1.6 cm) and mildly avid left supraclavicular nodes (up to 1.0 cm). B, Post-fourth treatment scan showed stable disease. Calcitonin decreased from 11,565 ng/L before surgery to 2895 ng/L pre-first treatment and 2517 ng/L post-fourth treatment (normal
