Hormonal crises following receptor radionuclide therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate

Bart de Keizer, Maarten O van Aken, Richard A Feelders, Wouter W de Herder, Boen L R Kam, Martijn van Essen, Eric P Krenning, Dik J Kwekkeboom, Bart de Keizer, Maarten O van Aken, Richard A Feelders, Wouter W de Herder, Boen L R Kam, Martijn van Essen, Eric P Krenning, Dik J Kwekkeboom

Abstract

Introduction: Receptor radionuclide therapy is a promising treatment modality for patients with neuroendocrine tumors for whom alternative treatments are limited. The aim of this study was to investigate the incidence of hormonal crises after therapy with the radiolabeled somatostatin analogue [(177)Lu-DOTA(0),Tyr(3)]octreotate ((177)Lu-octreotate).

Materials and methods: All (177)Lu-octreotate treatments between January 2000 and January 2007 were investigated. Four hundred seventy-six patients with gastroenteropancreatic neuroendocrine tumors and three patients with metastatic pheochromocytoma were included for analysis.

Results: Four hundred seventy-nine patients received a total of 1,693 administrations of (177)Lu-octreotate. Six of 479 patients (1%) developed severe symptoms because of massive release of bioactive substances after the first cycle of (177)Lu-octreotate. One patient had a metastatic hormone-producing small intestinal carcinoid; two patients had metastatic, hormone-producing bronchial carcinoids; two patients had vasoactive intestinal polypeptide-producing pancreatic endocrine tumors (VIPomas); and one patient had a metastatic pheochromocytoma. With adequate treatment, all patients eventually recovered.

Conclusion: Hormonal crises after (177)Lu-octreotate therapy occur in 1% of patients. Generally, (177)Lu-octreotate therapy is well tolerated.

Figures

Fig. 1
Fig. 1
Post-therapy scintigrams after 177Lu-octreotate of patient 1 (a), patient 2 (b), patient 3 (c), patient 4 (d), patient 5 (e), and patient 6 (f). Upper row Anterior images of the thorax, middle row anterior images of the abdomen, and lower row anterior images of the pelvic region. Note that the focal increased 177Lu-octreotate accumulations in liver metastases in all patients and focal uptake in bone metastases in patients 1, 2, and 4. In patient 6, there was also uptake in multiple lung metastases
Fig. 2
Fig. 2
Normetanephrines in 24 h urine (μmol) of patient 6 after 177Lu-octreotate treatment. Note the excessive release of normetanephrines after the first cycle of 177Lu-octreotate. Normal value urinary normetanephrines: <5.1 μmol/24 h

References

    1. Karmy-Jones R, Vallieres E. Carcinoid crisis after biopsy of a bronchial carcinoid. Ann Thorac Surg. 1993;56:1403–1405. doi: 10.1016/0003-4975(93)90696-F.
    1. Kharrat HA, Taubin H. Carcinoid crisis induced by external manipulation of liver metastasis. J Clin Gastroenterol. 2003;36:87–88. doi: 10.1097/00004836-200301000-00031.
    1. Ozgen A, Demirkazik FB, Arat A, Arat AR. Carcinoid crisis provoked by mammographic compression of metastatic carcinoid tumour of the breast. Clin Radiol. 2001;56:250–251. doi: 10.1053/crad.1999.0167.
    1. Vaughan DJA, Brunner MD. Anesthesia for patients with carcinoid syndrome. Int Anesthesiol Clin. 1997;35:129–142. doi: 10.1097/00004311-199703540-00009.
    1. Salm EF, Janssen M, Breburda CS, van Woerkens LJPM, de Herder WW, Zwaan Cvd, et al. Carcinoid crisis during transesophageal echocardiography. Intensive Care Med. 2000;26:254–254. doi: 10.1007/s001340050060.
    1. Lips CJ, Lentjes EG, Hoppener JW. The spectrum of carcinoid tumours and carcinoid syndromes. Ann Clin Biochem. 2003;40:612–627. doi: 10.1258/000456303770367207.
    1. Davi MV, Bodei L, Francia G, Bartolomei M, Oliani C, Scilanga L, et al. Carcinoid crisis induced by receptor radionuclide therapy with 90Y-DOTATOC in a case of liver metastases from bronchial neuroendocrine tumor (atypical carcinoid) J Endocrinol Invest. 2006;29:563–567. doi: 10.1007/BF03344149.
    1. Kaltsas GA, Papadogias D, Grossman AB. The clinical presentation (symptoms and signs) of sporadic and familial chromaffin cell tumours (phaeochromocytomas and paragangliomas) Front Horm Res. 2004;31:61–75. doi: 10.1159/000074658.
    1. Kwekkeboom DJ, Teunissen JJ, Bakker WH, Kooij PP, de Herder WW, Feelders RA, et al. Radiolabeled somatostatin analog [177Lu-DOTA0,Tyr3]octreotate in patients with endocrine gastroenteropancreatic tumors. J Clin Oncol. 2005;23:2754–2762. doi: 10.1200/JCO.2005.08.066.
    1. Kwekkeboom DJ, Bakker WH, Kooij PP, Konijnenberg MW, Srinivasan A, Erion JL, et al. [177Lu-DOTAOTyr3]octreotate: comparison with [111In-DTPAo]octreotide in patients. Eur J Nucl Med. 2001;28:1319–1325. doi: 10.1007/s002590100574.
    1. Bloom SR, Yiangou Y, Polak JM. Vasoactive intestinal peptide secreting tumors. Pathophysiological and clinical correlations. Ann N Y Acad Sci. 1988;527:518–527. doi: 10.1111/j.1749-6632.1988.tb27005.x.
    1. Caplin ME, Buscombe JR, Hilson AJ, Jones AL, Watkinson AF, Burroughs AK. Carcinoid tumour. Lancet. 1998;352:799–805. doi: 10.1016/S0140-6736(98)02286-7.
    1. Kizer JR, Koniaris LS, Edelman JD, St. John Sutton MG. Pheochromocytoma crisis, cardiomyopathy, and hemodynamic collapse. Chest. 2000;118:1221–1223. doi: 10.1378/chest.118.4.1221.
    1. Werbel SS, Ober KP. Pheochromocytoma. Update on diagnosis, localization, and management. Med Clin North Am. 1995;79:131–153. doi: 10.1016/S0025-7125(16)30088-8.
    1. Sasaki M, Iwaoka T, Yamauchi J, Tokunaga H, Naomi S, Inoue J, et al. A case of Sipple’s syndrome with malignant pheochromocytoma treated with 131I-metaiodobenzyl guanidine and a combined chemotherapy with cyclophosphamide, vincristine and dacarbazine. Endocr J. 1994;41:155–160. doi: 10.1507/endocrj.41.155.
    1. Safford SD, Coleman RE, Gockerman JP, Moore J, Feldman JM, Leight GS, et al. Iodine-131 metaiodobenzylguanidine is an effective treatment for malignant pheochromocytoma and paraganglioma. Surgery. 2003;134:956–962. doi: 10.1016/S0039-6060(03)00426-4.
    1. Bell HK, Poston GJ, Vora J, Wilson NJ. Cutaneous manifestations of the malignant carcinoid syndrome. Br J Dermatol. 2005;152:71–75. doi: 10.1111/j.1365-2133.2004.06273.x.
    1. Frojd C, Larsson G, Lampic C, von Essen L. Health related quality of life and psychosocial function among patients with carcinoid tumours. A longitudinal, prospective, and comparative study. Health Qual Life Outcomes. 2007;5:18. doi: 10.1186/1477-7525-5-18.
    1. Rolleman EJ, Kooij PP, de Herder WW, Valkema R, Krenning EP, de Jong M. Somatostatin receptor subtype 2-mediated uptake of radiolabelled somatostatin analogues in the human kidney. Eur J Nucl Med Mol Imaging. 2007;34(11):1854–1860. doi: 10.1007/s00259-007-0457-7.
    1. de Herder WW, Lamberts SW. Somatostatin and somatostatin analogues: diagnostic and therapeutic uses. Curr Opin Oncol. 2002;14:53–57. doi: 10.1097/00001622-200201000-00010.
    1. Oberg K, Kvols L, Caplin M, Delle Fave G, de Herder W, Rindi G, et al. Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol. 2004;15:966–973. doi: 10.1093/annonc/mdh216.
    1. Kvols LK, Martin JK, Marsh HM, Moertel CG. Rapid reversal of carcinoid crisis with a somatostatin analogue. N Engl J Med. 1985;313:1229–1230.
    1. Warner RR, Mani S, Profeta J, Grunstein E. Octreotide treatment of carcinoid hypertensive crisis. Mt Sinai J Med. 1994;61:349–355.

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