1. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors
- Author
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Strosberg, J, El Haddad, G, Wolin, E, Hendifar, A, Yao, J, Chasen, B, Mittra, E, Kunz, Pl, Kulke, Mh, Jacene, H, Bushnell, D, O'Dorisio, Tm, Baum, Rp, Kulkarni, Hr, Caplin, M, Lebtahi, R, Hobday, T, Delpassand, E, Van Cutsem, E, Benson, A, Srirajaskanthan, R, Pavel, M, Mora, J, Berlin, J, Grande, E, Reed, N, Seregni, E, Öberg, K, Lopera Sierra, M, Santoro, P, Thevenet, T, Erion, Jl, Ruszniewski, P, Kwekkeboom, D, Krenning, E, Ansquer, C, Baudin, E, Courbon, F, Giammarile, F, Taieb, D, Scheidhauer, K, Weber, M, Bodei, L, Brianzoni, E, DELLE FAVE, Gianfranco, Chiara Grana, M, Mariani, G, Rindi, G, Severi, S, Azevedo, I, Sundin, A, Al‐nahhas, A, Freemantle, N, Grossman, A, Manoharan, P, Anthony, L, Benson, Ab, Garbus, S, Kulke, M, Kvols, L, Metz, D, Morse, M, Schipper, M, Yao, J., and Radiology & Nuclear Medicine
- Subjects
Male ,medicine.medical_specialty ,Octreotide ,Antineoplastic Agents ,Kaplan-Meier Estimate ,Neuroendocrine tumors ,Gastroenterology ,Disease-Free Survival ,Drug Administration Schedule ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Organometallic Compounds ,medicine ,Clinical endpoint ,Humans ,Infusions, Intravenous ,Telotristat ethyl ,Aged ,Gastrointestinal Neoplasms ,Tumors ,DOTA-TATE ,Intestins ,business.industry ,Nausea ,General Medicine ,receptor radionuclide therapy ,radiolabeled somatostatin analog ,carcinoid-syndrome ,prognostic-factors ,survival ,prrt ,lu-177-dota-octreotate ,lu-177-octreotate ,scintigraphy ,octreotide ,Middle Aged ,medicine.disease ,Surgery ,Intestines ,Clinical trial ,Neuroendocrine Tumors ,chemistry ,Delayed-Action Preparations ,030220 oncology & carcinogenesis ,Radionuclide therapy ,Female ,business ,medicine.drug - Abstract
Background: Patients with advanced midgut neuroendocrine tumors who have had disease progression during first-line somatostatin analogue therapy have limited therapeutic options. This randomized, controlled trial evaluated the efficacy and safety of lutetium-177 ((177)Lu)-Dotatate in patients with advanced, progressive, somatostatin-receptor-positive midgut neuroendocrine tumors. Methods: We randomly assigned 229 patients who had well-differentiated, metastatic midgut neuroendocrine tumors to receive either (177)Lu-Dotatate (116 patients) at a dose of 7.4 GBq every 8 weeks (four intravenous infusions, plus best supportive care including octreotide long-acting repeatable [LAR] administered intramuscularly at a dose of 30 mg) ((177)Lu-Dotatate group) or octreotide LAR alone (113 patients) administered intramuscularly at a dose of 60 mg every 4 weeks (control group). The primary end point was progression-free survival. Secondary end points included the objective response rate, overall survival, safety, and the side-effect profile. The final analysis of overall survival will be conducted in the future as specified in the protocol; a prespecified interim analysis of overall survival was conducted and is reported here. Results: At the data-cutoff date for the primary analysis, the estimated rate of progression-free survival at month 20 was 65.2% (95% confidence interval [CI], 50.0 to 76.8) in the (177)Lu-Dotatate group and 10.8% (95% CI, 3.5 to 23.0) in the control group. The response rate was 18% in the (177)Lu-Dotatate group versus 3% in the control group (PConclusions: Treatment with (177)Lu-Dotatate resulted in markedly longer progression-free survival and a significantly higher response rate than high-dose octreotide LAR among patients with advanced midgut neuroendocrine tumors. Preliminary evidence of an overall survival benefit was seen in an interim analysis; confirmation will be required in the planned final analysis. Clinically significant myelosuppression occurred in less than 10% of patients in the (177)Lu-Dotatate group. (Funded by Advanced Accelerator Applications; NETTER-1 ClinicalTrials.gov number, NCT01578239 ; EudraCT number 2011-005049-11 .).
- Published
- 2017