Response assessment of somatostatin receptor targeted radioligand therapies for progressive intracranial meningioma.

Abstract

BACKGROUND:

 In somatostatin receptor (SSTR) expressing progressive meningioma, peptide receptor radionuclide therapy (PRRT) has shown effect in small clinical series. However, standardized treatment and response assessment protocols are lacking. We present our experience on PPRT with 177Lu-DOTATATE in progressive meningioma with a special emphasis on state-of-the-art response assessment.

METHODS:

 Retrospective analysis on PRRT with 177Lu-DOTATATE from 2015 to 2019. Pre- and post-therapy imaging was performed using MRI and 68Ga-DOTATATE-PET for standard bidimensional and volumetric analyses, respectively, following novel RANO guidelines.

RESULTS:

 Seven patients with progressive intracranial meningioma (median age 73 years, interquartile range 60-76; 5 WHO II, 2 WHO I; 5 multifocal) received a median of 4 cycles 2 3 4 of PRRT with 177Lu-DOTATATE in eight-week intervals. Three patients did not undergo post-therapy 68Ga-DOTATATE-PET due to early symptomatic progression and subsequent cessation of PRRT. After completion of 4 PRRT cycles volumetric PET imaging showed stable disease in two of four patients. According to bidimensional MRI response assessment, only one patient was stable. Progression free survival at six months was 42.9 %.

CONCLUSION:

 In this heterogeneous collective of seven patients with progressive meningioma, 177Lu-DOTATATE therapies showed heterogeneous effectiveness. PET-based volumetric assessment should be used for response assessment in PRRT additionally to bidimensional imaging.

• Authors: Michael Müther, Wolfgang Roll, Benjamin Brokinkel, Bastian Zinnhardt, Peter B Sporns, Robert Seifert, Michael Schäfers, Matthias Weckesser, Lars Stegger, Walter Stummer, Kambiz Rahbar
• Journal: Nuklearmedizin. Nuclear medicine (Nuklearmedizin) Vol. 59 Issue 5 Pg. 348-355 (Sep 2020) ISSN: 2567-6407 [Electronic] Germany
• Vernacular Title: Ansprechen auf Somatostatinrezeptor-Radioligandentherapie bei intrakraniellen Meningeomen.
• PMID: 32691404 (Publication Type: Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• 177Lu-DOTA-octreotate
• Coordination Complexes
• Ligands
• Receptors, Somatostatin
• Octreotide

Topics

• Adult
• Aged
• Coordination Complexes (therapeutic use)
• Female
• Humans
• Ligands
• Male
• Meningeal Neoplasms (diagnostic imaging, radiotherapy)
• Meningioma (diagnostic imaging, radiotherapy)
• Middle Aged
• Octreotide (analogs & derivatives, therapeutic use)
• Positron-Emission Tomography
• Receptors, Somatostatin (metabolism)
• Retrospective Studies
• Treatment Outcome