Peptide receptor radionuclide therapy (PRRT) in high grade neuroendocrine neoplasms: a systematic review and meta-analysis.
We performed a systematic review and meta-analysis to investigate the efficacy of peptide receptor radionuclide therapy (PRRT) by using radiolabeled somatostatin analogues in high grade gastro-entero-pancreatic neoplasms (GEP-NEN).
All clinical studies published up to March 2025, including patients with grade 3 (G3) GEP-NEN treated with [177Lu] Lu-DOTA-TATE and/or [90Y] Y-SSA, were identified based on systematic searches in the PubMed and Embase databases. Eligible studies had to report at least one of the following outcomes: 1) response to therapy evaluated according to RECIST (version 1.1 as complete response, partial response, stable disease, progressive disease; 2) median progression free survival (PFS) with 95% confidence intervals (CI); 3) median overall survival (OS) with 95% CI. Objective response rate (ORR) and disease control rate (DCR) were considered as primary outcomes.
The final analysis included 7 studies accounting for a total of 317 patients with G3 disease (ranging from 18 to 112). Six studies evaluated response to therapy according to RECIST in 288 patients, and in 4 of them patients were also stratified according to ki67 values. The pooled ORR and DCR were 34% (95% CI: 22-46) and 64% (95% CI: 52-76), respectively. The funnel plot indicated no publication bias among these studies. Five studies reported in 239 patients median PFS with 95% CI, with a pooled estimate of 13.88 (95% CI: 10.33-18.64) months. Three studies fully reported in 174 patients median OS with 95% CI, with a pooled estimate of 29.95 (95% CI: 19.80-45.30) months.
In patients with G3 GEP-NEN, PRRT may provide substantial disease control and response rates, and it seems able to delay the progression of the disease.
All clinical studies published up to March 2025, including patients with grade 3 (G3) GEP-NEN treated with [177Lu] Lu-DOTA-TATE and/or [90Y] Y-SSA, were identified based on systematic searches in the PubMed and Embase databases. Eligible studies had to report at least one of the following outcomes: 1) response to therapy evaluated according to RECIST (version 1.1 as complete response, partial response, stable disease, progressive disease; 2) median progression free survival (PFS) with 95% confidence intervals (CI); 3) median overall survival (OS) with 95% CI. Objective response rate (ORR) and disease control rate (DCR) were considered as primary outcomes.
The final analysis included 7 studies accounting for a total of 317 patients with G3 disease (ranging from 18 to 112). Six studies evaluated response to therapy according to RECIST in 288 patients, and in 4 of them patients were also stratified according to ki67 values. The pooled ORR and DCR were 34% (95% CI: 22-46) and 64% (95% CI: 52-76), respectively. The funnel plot indicated no publication bias among these studies. Five studies reported in 239 patients median PFS with 95% CI, with a pooled estimate of 13.88 (95% CI: 10.33-18.64) months. Three studies fully reported in 174 patients median OS with 95% CI, with a pooled estimate of 29.95 (95% CI: 19.80-45.30) months.
In patients with G3 GEP-NEN, PRRT may provide substantial disease control and response rates, and it seems able to delay the progression of the disease.
Authors
Zampella Zampella, Piscopo Piscopo, Green Green, Cantoni Cantoni, Nappi Nappi, Gaudieri Gaudieri, Caiazzo Caiazzo, Scaglione Scaglione, Cuocolo Cuocolo, Klain Klain
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