Long-Term Safety of Bland Embolization Prior to Peptide Receptor Radionuclide Therapy

Sunday, March 5, 2023

3:00 PM – 3:09 PM

Location: Phoenix Convention Center, 227ABC

Presenting Author(s)

Adam Alayli, B.S.

Medical Student
University of South Florida Morsani College of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

HN

Hoang Ngo, B.S.

Medical Student
University of South Florida Morsani College of Medicine
ES

Elias Salloum, MD

Assistant Member in the Department of Diagnostic Imaging and Interventional Radiology
Moffitt Cancer Center
Altan Ahmed, MD

Assistant Member, Department of Diagnostic Imaging and Interventional Radiology
H. Lee Moffitt Cancer Center & Research Institute
Bela Kis, MD, PhD, FSIR (he/him/his)

Chief of Interventional Radiology
Moffitt Cancer Center
JS

Jonathan Strosberg, MD

Professor
H Lee Moffitt Cancer Center
Ghassan El-Haddad, MD

Senior Member Interventional Radiology, Medical Director Radionuclide Therapy Program
Moffitt Cancer Center and Research Institute

Disclosure(s):

Adam Alayli, B.S.: No financial relationships to disclose

Bela Kis, MD, PhD, FSIR: Varian Medical Systems: Consultant (Ongoing)

Ghassan El-Haddad, MD: No relevant disclosure to display

Purpose: Evaluate long-term safety of hepatic bland embolization for patients with metastatic neuroendocrine tumors (mNET) who subsequently received Peptide Receptor Radionuclide Therapy (PRRT).

Materials and Methods: Retrospective review of mNET patients who received at least 2 cycles of PRRT with 177Lu-DOTATATE between 4/2018 and 02/2022 with and without prior hepatic bland embolization (TAE). Patients followed for at least 6 months after last PRRT cycle. Most recent clinical, imaging and laboratory findings including hepatic CTCAE v5.0 were compared to pre-PRRT.

Results: 181 patients (103 M, 78 F, mean age=64) with mNET (G1:68, G2:82, G3:14, unknown: 17) of different primary sites (9 foregut, 104 midgut, 9 hindgut, 49 pancreas, 1 lung, 9 unknown) underwent at least 2 cycles of PRRT, 105 of whom were embolization naïve and 76 had prior TAE. Median follow up was 22 months (range: 6-43). Patients with prior TAE had higher liver tumor burden on average (0%: 0, 0-25%: 51, 25-50%: 18, 50%+: 7) than patients without prior TAE (0%: 13, 0-25%: 73, 25-50%: 14, 50%+: 5) (p=0.012). No statistically significant difference seen in long term hepatotoxicity between the two groups. 7 patients in TAE naïve group exhibited long-term G3 hepatotoxicity (bilirubin, AST, ALT, ALP) compared to 9 patients who had prior TAE (bilirubin, AST, ALP) (p=0.226). None of the patients who completed less than 2 cycles of PRRT had G3/G4 hepatotoxicity.

Conclusion: Even though mNET patients who undergo TAE prior to PRRT often have a higher liver tumor burden than their embolization naïve counterparts, these patients have low risk of long-term high-grade hepatotoxicity. Patients with liver dominant metastatic mNET can safely receive PRRT after bland TAE.