Response, Survival, and Long-Term Toxicity After Therapy With the Radiolabeled Somatostatin Analogue 90Y-DOTA-TOC in Metastasized Neuroendocrine Cancers

PURPOSE: To investigate response, survival, and safety profile of the somatostatin-based radiopeptide (90)yttrium-labeled tetraazacyclododecane-tetraacetic acid modified Tyr-octreotide ((90)Y-DOTA-TOC) in neuroendocrine cancers. PATIENTS AND METHODS: In a clinical phase II single-center open-label trial, patients with neuroendocrine cancers were treated with repeated cycles of (90)Y-DOTA-TOC. Each cycle consisted of a single intravenous injection of 3.7GBq/m(2) body-surface (90)Y-DOTA-TOC. Additional cycles were withheld in case of tumor progression and/or permanent toxicity. RESULTS: Overall, 1,109 patients received 2,472 cycles of (90)Y-DOTA-TOC (median, two; range, one to 10 cycles per patient). Of the 1,109 patients, 378 (34.1%) experienced morphologic response; 172 (15.5%), biochemical response; and 329 (29.7%), clinical response. During a median follow-up of 23 months, 491 patients (44.3%) died. Longer survival was correlated with each: morphologic (hazard ratio HR, 0.46; 95% CI, 0.38 to 0.56; median survival, 44.7 v 18.3 months; P < .001), biochemical (HR, 0.75; 95% CI, 0.59 to 0.96; 35.3 v 25.7 months; P = .023), and clinical response (HR, 0.68; 95% CI, 0.56 to 0.82; 36.8 v 23.5 months; P < .001). Overall, 142 patients (12.8%) developed grade 3 to 4 transient hematologic toxicities, and 103 patients (9.2%) experienced grade 4 to 5 permanent renal toxicity. Multivariable regression revealed that tumoral uptake in the initial imaging study was predictive for overall survival (HR, 0.45; 95% CI, 0.29 to 0.69; P < .001), whereas the initial kidney uptake was predictive for severe renal toxicity (HR, 1.59; 95% CI, 1.17 to 2.17; P = .003). CONCLUSION: This study documents the long-term outcome of (90)Y-DOTA-TOC treatment in a large cohort. Response to (90)Y-DOTA-TOC is associated with longer survival. Somatostatin receptor imaging is predictive for both survival after (90)Y-DOTA-TOC treatment and occurrence of renal toxicity.