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

  • NETs
  • QoL
  • PRRT
  • Lutetium

• Graduation date

  Fall 2019

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-k4ht-qe28

• License

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