Meena Darden, MS4June 26, 2019

Diagnostic Radiology 4001 ElectiveDr. Lesley Flynt, Nuclear Medicine, MD Anderson

Meena Darden, MS4June 26, 2019

Diagnostic Radiology 4001 ElectiveDr. Lesley Flynt, Nuclear Medicine, MD Anderson

68Gallium-DOTATATE & Lutathera in Pancreatic Neuroendocrine Tumor

Imaging & Treatment

54 Y.O. MALEMETASTATIC GRADE 2 PANCREATIC NEUROENDOCRINE TUMOR

➔ 2012: Gemcitabine x Cisplatin➔ 2013: Nanoknife ablation➔ 2013: Capecitabine chemoradiation➔ 2013: Recurrent pancreatic mass +

porta hepatis lymph node➔ 2015: Enlarging precaval lymph

nodes adjacent to SMA➔ 2015: Ethanol ablation➔ 2015-16: Lanreotide➔ 2016: Ribociclib➔ 2018: Everolimus➔ 2018: Enlarging adenopathy➔ 2018: 177Lu-DOTATATE

HISTORY

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DIAGNOSIS

3

IMAGING OPTIONS

Triple Phase CTDCE-CTMRIUSSSR Scintigraphy (Octreoscan)68Ga-DOTATATE18F-FDGPET/CT

DEFINITIONS

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68Gallium-DOTATATE (NETSPOT)- Positron-emitting analog of somatostatin that binds to SST receptors on NETs- Used during PET scans

177Lutetium-DOTATATE (Lutathera)- Peptide receptor radiotherapy (PRRT) for advanced, progressive, somatostatin-receptor-

positive midgut neuroendocrine tumors- Liver metastases

IMAGES

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Pre-Lutathera

IMAGES

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Pre-Lutathera

IMAGES

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Pre-Lutathera Post-Lutathera

IMAGES

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Post-Lutathera

PRE-LUTATHERA

- Primary mass: pancreatic head/body + lymphadenopathy- Liver metastasis- DOTATATE-avid lymph nodes in chest, abdomen, pelvis

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POST-LUTATHERAMarked changes in avidity most prominent in

liver metastasis and lymphadenopathy

FINDINGS

American College of Radiology ACR Appropriateness Criteria®: Staging of Pancreatic Ductal Adenocarcinoma

TAKE HOME POINTS

68Ga-DOTATATEPositron-emitting analog of somatostatin that binds to SST receptors on NETs

Radiolabeled SST analog used for peptide receptor radionuclide therapy

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177Lu-DOTATATE

The combination of these radiological technologies enables more accurate, less invasive, and more complete therapy targeting neuroendocrine tumors and other hormone-sensitive malignancies, thus altering the trajectory of cancer treatment and survival.

THERANOSTICS

REFERENCES

● 68Ga-DOTA-Tyr3-Octreotide PET in Neuroendocrine Tumors: Comparison with Somatostatin Receptor Scintigraphy and CT, http://jnm.snmjournals.org/content/48/4/508.short

● American College of Radiology ACR Appropriateness Criteria® Staging of Pancreatic Ductal Adenocarcinoma https://acsearch.acr.org/docs/3099847/Narrative/

● Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors https://www.nejm.org/doi/full/10.1056/NEJMoa1607427

● Recent developments in imaging of pancreatic neuroendocrine tumors https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367208/

● The value of 68Ga-DOTATATE PET/CT in diagnosis and management of neuroendocrine tumors compared to current FDA approved imaging modalities: a review of literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138137/pdf/ajnmmi0004-0426.pdf

● Update on pancreatic neuroendocrine tumors https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244504/

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QUESTIONS?

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