Efficacy and safety of 177Lu-DOTATATE targeted therapy in advanced/metastatic pulmonary neuroendocrine tumors: A systematic review and meta-analysis

Jiao Ma; Xin Hu; Lanying Li; Zijuan Rao; Chunyin Zhang

doi:10.3389/fonc.2022.993182

Efficacy and safety of ¹⁷⁷Lu-DOTATATE targeted therapy in advanced/metastatic pulmonary neuroendocrine tumors: A systematic review and meta-analysis

Front Oncol. 2022 Nov 24:12:993182. doi: 10.3389/fonc.2022.993182. eCollection 2022.

Authors

Jiao Ma¹, Xin Hu², Lanying Li¹, Zijuan Rao¹, Chunyin Zhang^{1

3

4}

Affiliations

¹ Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
² Department of Orthopedics, Second People's Hospital of Yibin City, Yibin, Sichuan, China.
³ Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China.
⁴ Academician (expert) Workstation of Sichuan Province, Luzhou, Sichuan, China.

Abstract

Objective: To perform a meta-analysis of the efficacy and safety about ¹⁷⁷Lu-DOTATATE therapy for advanced/metastatic pNETs based on the current clinical evidence.

Methods: This systematic review follows the PRISMA guideline. Search PubMed, Medline, EMBASE and CNKI, VIP, Wanfang databases, from establishment to June 2022, on the study of ¹⁷⁷Lu-DOTATATE for advanced/metastatic pNETs, the primary endpoint was to evaluate the treatment effect through DRRs and DCRs. Secondary endpoint included assessment of OS, PFS, and treatment-related adverse events across all studies. Two researchers conducted literature screening, data extraction and quality evaluation according to the inclusion and exclusion criteria. Meta-analysis was performed using stata16.0 software, and the data were merged and displayed using forest graphs.

Results: A total of 5 studies, 174 patients, on ¹⁷⁷Lu-DOTATATE for advanced/metastatic pNETs were included. The pools of DRRs and DCRs were 24% (95% CI: 15%~32%) and 77% (95% CI: 62%~92%), respectively. The pool of OS was 48.78 months (95% CI: 41~56.57 months) and the pool of PFS was 21.59 months (95% CI: 17.65~25.53 months). In all studies, the most common side effect of treatment was hematological toxicity. In 174 patients, hematological toxicity of grade III accounted for 4.0% (7/174), and only 4.0% (7/174) and 1.0% (2/174) of patients had mild nephrotoxicity and hepatotoxicity. Gastrointestinal adverse reactions in 3% (6/174), nausea in 2% (3/174), superior vena cava occlusion in 0.5% (1/174).

Conclusion: ¹⁷⁷Lu-DOTATATE is effective and safe for advanced/metastatic pNETs, which can delay the progression of the disease, may improve patients' survival, and has low treatment-related toxicity and high safety. However, its efficacy and safety need to be further evaluated in high-quality, multicenter randomized controlled trials in the future.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022344436.

Keywords: 177Lu-DOTATATE; lung; meta-analysis; neuroendocrine tumors; radionuclide therapy.

Publication types

Systematic Review