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. 2021 Mar;28(3):203-212.
doi: 10.1530/ERC-20-0482.

A clinical score for neuroendocrine tumor patients under consideration for Lu-177-DOTATATE therapy

Satya Das  1 , Liping Du  2 , Aimee Schad  3 , Shikha Jain  4 , Aaron Jessop  5 , Chirayu Shah  5 , David Eisner  1 , Dana Cardin  1 , Kristen Ciombor  1 , Laura Goff  1 , Marques Bradshaw  5 , Dominique Delbeke  5 , Martin Sandler  5 , Jordan Berlin  1
Affiliations

A clinical score for neuroendocrine tumor patients under consideration for Lu-177-DOTATATE therapy

Satya Das et al. Endocr Relat Cancer. 2021 Mar.

Abstract

We developed a clinical score (CS) at Vanderbilt Ingram Cancer Center (VICC) that we hoped would predict outcomes for patients with progressive well-differentiated neuroendocrine tumors (NETs) receiving therapy with Lutetium-177 (177Lu)-DOTATATE. Patients under consideration for 177Lu-DOTATATE between March 1, 2016 and March 17, 2020 at VICC were assigned a CS prospectively. The CS included 5 categories: available treatments for tumor type outside of 177Lu-DOTATATE, prior systemic treatments, patient symptoms, tumor burden in critical organs and presence of peritoneal carcinomatosis. The primary outcome of the analysis was progression-free survival (PFS). To evaluate the effect of the CS on PFS, a multivariable Cox regression analysis was performed adjusting for tumor grade, primary tumor location, and the interaction between 177Lu-DOTATATE doses received (zero, 1-2, 3-4) and CS. A total of 91 patients and 31 patients received 3-4 doses and zero doses of 177Lu-DOTATATE, respectively. On multivariable analysis, in patients treated with 3-4 doses of 177Lu-DOTATATE, for each 1-point increase in CS, the estimated hazard ratio (HR) for PFS was 2.0 (95% CI 1.61-2.48). On multivariable analysis, in patients who received zero doses of 177Lu-DOTATATE, for each 1-point increase in CS, the estimated HR for PFS was 1.22 (95% CI 0.91-1.65). Among patients treated with 3-4 doses of 177Lu-DOTATATE, those with lower CS experienced improved PFS with the treatment compared to patients with higher CS. This PFS difference, based upon CS, was not observed in patients who did not receive 177Lu-DOTATATE, suggesting the predictive utility of the score.

Keywords: clinical score; lutetium-177-DOTATATE; patient outcomes; peptide receptor radionuclide therapy.

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Conflict of interest statement

Declaration of Interest

None of the authors declare a conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves for PFS in patients, based upon CS and PRRT doses administered. Log-rank test p < 0.0001. Abbreviations: PFS, progression-free survival; CS, Clinical Score; PRRT, peptide receptor radionuclide therapy
Figure 2.
Figure 2.
Effects of CS by PRRT dose on PFS from the multivariable Cox regression analysis. Note, each line corresponds to a different PRRT dose group (zero, 1–2, 3–4). P values for effect of tumor grade, primary tumor site and the interaction between CS and PRRT dose were .041, .021 and 0.006 respectively. Abbreviations: PFS, progression-free survival; CS, Clinical Score
Figure 3.
Figure 3.
Kaplan-Meier Curves for OS in patients, based upon CS and PRRT doses administered. Log-rank test p < 0.0001. Abbreviations: OS, overall survival; CS, Clinical Score; PRRT, peptide receptor radionuclide therapy
Figure 4.
Figure 4.
Effects of CS by PRRT dose on OS from the multivariable Cox regression analysis. Note, each line corresponds to a different PRRT dose group (zero, 1–2, 3–4). P values for effect of CS and dose were 0.0005 and < .0001 respectively. Abbreviations: OS, overall survival; CS, Clinical Score; PRRT, peptide receptor radionuclide therapy
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