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THE ROLE OF LUTETIUM-177 IN THE TREATMENT OF METASTATIC GASTROENTEROPANCREATIC TUMORS
- Author / Creator
- Saravana-Bawan, Bianka, B
The incidence of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has been
increasing over recent decades. Lutetium therapy has demonstrated benefit towards quality of
life (QoL) overall in patients with metastatic GEP-NETs. However, factors influencing individual
response to 177Lu-DOTATATE with regards to QoL, and methods for easy integration of QoL
monitoring into clinical practice are not yet well understood. This work seeks to identify optimal
methods for QoL assessment and prognostic factors for QoL response in patients with
progressive GEP-NETs treated with 177Lu-DOTATATE.
This study was conducted as part of the Phase II open label clinical trial at the Cross Cancer
Institute in Edmonton. Treatment consisted of an induction phase of 5.55 GBq administered at
four treatments, 10 weeks apart. QoL over 177Lu-DOTATATE treatment was assessed with
EORTC QLQ-C30, GI.NET-21 and ESAS-r at baseline and subsequent to each treatment. Planned
analysis of change in QoL by corresponding assessment method and factors related to change
in QoL was completed in all patients with GEP-NETs. Repeated measures ANOVA was
performed to assess QoL change and purposeful logistic regression for identification of
In total 85 patients met inclusion criteria. Both EORTC and ESAS-r demonstrated maintained
overall quality of life. EORTC demonstrated statistically and clinically significant improvement in
insomnia, GI and endocrine symptoms. ESAS-r demonstrated statistically but no clinically
significant improvement in insomnia, anxiety and emotional functioning.
In the final regression model for prognostic factors for QoL a statistically significant correlation
was demonstrated between global health score at baseline and time from diagnosis to
treatment initiation with 177Lu-DOTATATE. The presence of metastatic disease was marginally
statistically significant with regards to change in global health score after 177Lu-DOTATATE
177Lu-DOTATATE is not only effective in improving PFS for patients with metastatic GEP-NETs
but also impacts overall quality of life. Consideration in treatment initiation in this palliative
setting should include potential impact to patient QoL as the impact of 177Lu-DOTATATE therapy
on QoL improvement appears to decrease in correlation to delay in 177Lu-DOTATATE treatment.
To monitor changes in QoL during treatment all assessment tools have inherent benefits and
limitations which must be considered in clinical use. ESAS-r provides a quick and easy to
interpret tool; however, it is not NET specific and as such may not be as sensitive in this
population. The EORTC assessment questionnaires better reflect QoL in the NET population.
Modifications or use of computer integration could be considered to facilitate clinical
- Graduation date
- Fall 2019
- Type of Item
- Master of Science
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