Minimal Risk of Liver Failure Identified With Theranostics in GEP-NETs

Treatment with peptide receptor radionuclide therapy (PRRT) did not result in the development of liver failure during the treatment of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), particularly among patients with a very high liver tumor burden. CancerNetwork® spoke with Jason Starr, DO, at the 3^rd Biennial Miami Precision Medicine Conference, about a session he gave regarding precision tools for personalized prognosis and therapy of NETs.

He began by identifying a concern regarding the potential for PRRT to confer hepatotoxicity among patients with GEP-NETs, especially among those with high volume or liver-metastatic disease. Next, he identified research he authored and published in The Journal of Nuclear Medicine, which revealed that among patients with GEP-NETs, particularly those with a higher volume of disease (n = 15), defined as having more than 75% liver involvement, only 1 experienced hepatoxicity. In conclusion, he stated that in spite of the low sample size of the patient population, it was the largest study to examine rates of hepatotoxicity among these patients.

Starr is an oncologist of the Early-Onset Colorectal Cancer Group in the Department of Internal Medicine at Mayo Clinic Comprehensive Cancer Center.

Transcript:

One of the concerns we had with [lutetium Lu 177 dotatate] PRRT is whether you can develop hepatotoxicity based on prior treatments. For example, patients will not infrequently get a treatment called yttrium-90 [Y-90] radioembolization to the liver, [but] also the volume of disease in the liver. If the PRRT and all that therapy is going to the liver, and then [we are] delivering the radiation, is the liver at risk for developing injury? The study that we published showed that even patients with extremely heavy volume of disease in the liver did not appear to develop liver failure as a result of the PRRT. That was encouraging. It was a small sample size of patients, but the largest experience reported to date.

Reference

Gococo-Benore DA, Kuhlman J, Parent EE, et al. Evaluation of hepatotoxicity from peptide receptor radionuclide therapy in patients with gastroenteropancreatic neuroendocrine tumors and a very high liver tumor burden. J Nucl Med. 2023;64(6):880-884. doi:10.2967/jnumed.122.264533