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THE ROLE OF LUTETIUM-177 IN THE TREATMENT OF METASTATIC GASTROENTEROPANCREATIC TUMORS

  • Author / Creator
    Saravana-Bawan, Bianka, B
  • Purpose
    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.
    Methods
    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
    prognostic factors.
    Results
    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.
    ii
    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
    induction therapy.
    Conclusions
    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
    incorporation.

  • Subjects / Keywords
  • Graduation date
    Fall 2019
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/r3-k4ht-qe28
  • License
    Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.