A 50-year-old male with pancreatic neuroendocrine cancer and metastases to the liver and bones. History of treatment with radiation therapy to the pancreatic mass, chemotherapy, chemoembolization, cold sandostatin, and radionuclide hepatic embolization in the past, presents with progressive disease. His symptoms include abdominal pain, nausea, vomiting, and diarrhea. His Karnofsky performance score is 70 and neuroendocrine markers are elevated: Chromogranin A of 58, Pancreastatin of 1920, and Gastrin of 358. FDG PET/CT image below (left) shows multiple bilobar hepatic metastases and two hypermetabolic foci in the bones: left scapula, and right side of pelvis. These lesions were positive on In-111 Octreotide imaging.

He met the inclusion and exclusion criteria for investigational PRRT (Peptide Receptor Radionuclide Therapy) with Lu-177 Octreotate, and received two cycles of therapy with 195.1 mCis and 191.0 mCis of Lu-177 Octreotate, 6 weeks apart. At the time that he presented for the third cycle of therapy, he was doing much better, and most of his symptoms had resolved. His Karnofsky performance score was 90 and there was a significant decrease in the levels of neuroendocrine markers: Chromogranin A of 3, Pancreastatin of 256, and Gastrin of 60. FDG PET/CT image above (right) shows good response to PRRT with partial response by RECIST criteria.

Representative images from MRI (above) show a significant improvement in liver metastases. The protocol includes IV injection of 200 mCi of Lu-177 Octreotate, 6-9 weeks apart, for a total of 4 cycles, for patients with unresectable metastatic neuroendocrine cancers, positive on In-111 Octreotide imaging. Patients are monitored closely for renal and hematologic toxicity.

1. Lutetium-labelled peptides for therapy of neuroendocrine tumours. Kam BL, Teunissen JJ, Krenning EP, de Herder WW, Khan S, van Vliet EI, Kwekkeboom DJ. Eur J Nucl Med Mol Imaging. 2012 Feb;39 Suppl 1:S103-12

2. Somatostatin receptor-targeted radionuclide therapy in patients with gastroenteropancreatic neuroendocrine tumors. Kwekkeboom DJ, de Herder WW, Krenning EP. Endocrinol Metab Clin North Am. 2011 Mar;40(1):173-85.