Peptide Receptor Radionuclide Therapy with 177 Lu-DOTATATE in Carcinoid Heart Disease: A Contraindication or a Promising Treatment Approach Bettering Chances for Corrective Surgery?

We report the gratifying response of functioning metastatic neuroendocrine tumor with carcinoid heart disease (uncontrolled by long-acting octreotide) to treatment with ¹⁷⁷ Lu-DOTATATE. This response favorably altered the clinical course of the patient, enabling corrective valvular surgery, enhancing health-related quality of life, improving symptoms (from New York Heart Association grade III at baseline to grade I after 6 cycles), stabilizing the disease, and substantially reducing the level of 5-hydroxyindole acetic acid. Avoiding concerns about volume overload by administering amino acids over a relatively prolonged period of 7.5-8 h during peptide receptor radionuclide therapy could be particularly helpful and could be conveniently adopted in this clinical setting. Considering the significantly shortened overall survival of patients with carcinoid heart disease, the relative paucity of available treatment options, and the risk of complications during corrective surgery on poorly controlled functioning disease, ¹⁷⁷ Lu-DOTATATE can emerge as a potent option in this group of patients.
(© 2018 by the Society of Nuclear Medicine and Molecular Imaging.)