Hematological Toxicity of Combined Lutetium‐177 octreotate Radiopeptide‐Chemotherapy of Gastro‐entero‐pancreatic Neuroendocrine Tumors Followed Long‐term

Combination of peptide receptor radiopeptide  therapy with radiosensitizing chemotherapy for Gastroenteropancreatic NETs may improve efficacy compared to PRRT alone, however , there are concerns regarding increased myelotoxicity.

This prospective study examined the incidence of haematological toxicity of combination Lutetium DOTATATE therapy in combination with capecitabine and temozolomide.

In this study 65 patients were treated with 4 cycles of 7.8 GBq Lu-octreotate therapy, 1650mg/m2 capecitabine (n=28) and the remaining patients had Lu-octreotate therapy with 1500mg/m2 capecitabine with 200mg/m2 temozolomide (n=37). Patients were followed up for 5 years.

1 patient developed self-limited haematological toxicity grade 3/4. 1 patient treated with capecitabine and Lu-octreotate therapy developed significant anaemia and thrombocytopenia over the long term follow up period of 60 months.

Long term complications in the patients undergoing Lu-octreotate, capecitabine and temozolmide were thrombocytopenia 2.7% (1 patient), neutropenia 2.7% and anaemia 10.8%.

The median 3 year findings were lower haemoglobin and platelet counts. Two patients developed myleodysplasia.

There appears to be haematological toxicity of PRRT in combination chemotherapy in GEP NETs. 

Source: Neuroendocrinology