Advanced pancreatic neuroendocrine tumors (pNETs) present a therapeutic challenge with targeted therapies like Everolimus and 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) showing beneficial effects in various cohort studies and randomized trials. Currently there is a paucity of trials with head-to-head comparison between PRRT and Everolimus in advanced pNETs. This systematic review was conducted to compare the therapeutic efficacy and safety profile of 177Lu-DOTATATE and Everolimus in advanced pNETs.
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches in Pubmed, Scopus and Embase using relevant keywords selected articles up to June 2019. Data on efficacy and safety were extracted from the individual articles. Random effects model was used for meta-analysis.
Fifteen articles consisting of 697 patients reported on 177Lu-DOTATATE and 12 articles consisting of 946 patients reported on Everolimus. Overall, treatment with 177Lu-DOTATATE had better objective response rate (47% vs. 12%, P < 0.001) and disease control rate (81% vs. 73%, P < 0.001) and longer progression-free survival (25.7 months vs. 14.7 months, P < 0.001) than with Everolimus. 177Lu-DOTATATE also had a better safety profile than Everolimus with fewer patients showing grade 3/4 hematological toxicity (5% vs. 11%, P = 0.02) and nephrotoxicity (1% vs. 2.5%, P = 0.34). Treatment-related adverse events caused discontinuation of therapy more frequently for Everolimus than for 177Lu-DOTATATE (59 out of 371 patients vs. 0 out of 128 patients).
From this meta-analysis, 177Lu-DOTATATE showed better therapeutic efficacy and safety profile compared to Everolimus in advanced pNETs.
Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Received 15 July 2019 Accepted 22 September 2019
Correspondence to Bhagwant Rai Mittal, MD, DNB, Department of Nuclear Medicine & PET, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India, Tel: +91 9914209722; fax; +91 1722744401; e-mail: email@example.com