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Initial Experience With Gallium-68 DOTA-Octreotate PET/CT and Peptide Receptor Radionuclide Therapy for Pediatric Patients With Refractory Metastatic Neuroblastoma

Kong, Grace MBBS (Hons), FRACP, FAANMS; Hofman, Michael S. MBBS (Hons), FRACP, FAANMS; Murray, William K. MBBS, FRCPA, FRCPath; Wilson, Sharyn BAppSc, MHlthSc; Wood, Paul MBBS, BPharm, MSc, FRACP; Downie, Peter MBBS, FRACP; Super, Leanne MBBS, FRACP; Hogg, Annette BAppSc, PhD; Eu, Peter BSc (Pharmacy), MSc (Radiopharmacy); Hicks, Rodney J. MBBS (Hons), MD, FRACP

Journal of Pediatric Hematology/Oncology: March 2016 - Volume 38 - Issue 2 - p 87–96
doi: 10.1097/MPH.0000000000000411
Original Articles

Rationale: Pediatric patients with refractory neuroblastoma have limited therapeutic options. Neuroblastoma may express somatostatin receptors (SSTRs) allowing imaging with 68Ga-DOTA-Octreotate (GaTATE) positron emission tomography/computed tomography (PET/CT) and peptide receptor radionuclide therapy (PRRT). We reviewed our experience with this theranostic combination.

Materials and Methods: GaTATE studies (8 patients; 2 to 9 years old) were reviewed and compared with 123I-MIBG or posttreatment 131I-MIBG studies. Immunohistochemistry (IHC) for SSTR subtype 2 was performed in 5 patients. Four patients received PRRT.

Results: GaTATE PET showed additional disease in 38% (3/8 patients), and upstaged 1 patient by detecting marrow involvement. IHC detected SSTR 2 in all patients assessed. Six patients were deemed suitable for PRRT on imaging. Four patients received 17 cycles of palliative PRRT (10 111In-DOTATATE; 5 177Lu-DOTATATE; 1 combined 111In and 177Lu-DOTATATE; 1 combined 177Lu and 90Y-DOTATATE) with no significant toxicity attributed to PRRT. All had objective responses. Two survivors are now 40 and 56 months from PRRT commencement.

Conclusions: GaTATE PET was positive in a high proportion of patients with refractory neuroblastoma, correlating with SSTR 2 on IHC, with additional disease identified compared with MIBG imaging. PRRT seems safe, feasible, with responses observed in patients with progression despite multimodality treatment. These data support ongoing clinical trials in such patients.

*Centre for Cancer Imaging

Department of Pathology

Translational Research Laboratory, Peter MacCallum Cancer Centre

§Children’s Cancer Centre, Monash Health, Victoria

Department of Paediatrics, Monash University

#Children’s Cancer Centre, Royal Children’s Hospital Melbourne, Melbourne

Department of Medicine

**The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Parkville, Vic., Australia

The authors declare no conflict of interest.

Reprints: Rodney J. Hicks, MBBS (Hons), MD, FRACP, Centre for Cancer Imaging, The Peter MacCallum Cancer Centre, St Andrew’s Place, East Melbourne, Vic. 3002, Australia (e-mail: rod.hicks@petermac.org).

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Received February 14, 2015

Accepted June 30, 2015

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