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Various toxicities: 4 case reports In a retrospective study of 48 patients (aged 22–81 years) with lung neuroendocrine tumour (NET) treated in Australia between 1 January 2002 and 30 June 2019, 4 patients including a woman and an 81-year-old patient [not all ages and sexes stated] were described, who developed fatal acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) leading to fatal AML, nausea or acute kidney injury during treatment with lutetium-(177Lu)-oxodotreotide for lung NET [dosages not stated; not all times to reactions onsets stated]. All patients, who had lung NET, were scheduled to receive peptide receptor radionuclide therapy (PRRT) with lutetium-(177Lu)oxodotreotide. One patient had carcinoid syndrome with severe diarrhoea resulting in volume depletion. One woman had been previously heavily treated with streptozocin [streptozotocin], fluorouracil [5-fluorouracil] and multiple courses of radiotherapy, and the 81-year-old patient had been previously treated with unspecified somatostatin analogues. They all received a renoprotective amino acid infusion, followed PRRT with IV lutetium-(177Lu)-oxodotreotide, using a standard single day protocol. Each administration of PRRT was considered as one treatment dose. The 81-year-old patient, who had a normal blood film at PRRT commencement, received 4 doses of PRRT with IV Lutetium-(177Lu)-oxodotreotide at a cumulative dose of 29.35GBq, and the patient concurrently received fluorouracil [5-fluorouracil]. However, they all developed toxicities secondary to PRRT with lutetium(177Lu)-oxodotreotide. The woman, who had been heavily pretreated developed AML, which was diagnosed at the time of the first lutetium-(177Lu)-oxodotreotide course, following the second lutetium-(177Lu)-oxodotreotide dose. The AML developed 8-10 weeks after the initiation of PRRT with lutetium-(177Lu)-oxodotreotide and ~4 years after treatment with streptozocin. The 81 year old patient initially developed myelodysplastic syndrome (MDS) 48 months after PRRT with lutetium-(177Lu)-oxodotreotide, and the MDS transformed to AML after a year. Cytogenetics suggested PRRT (lutetium-(177Lu)-oxodotreotide)-related AML. Another patient, who had carcinoid syndrome, developed acute kidney injury, which occurred during the first lutetium-(177Lu)oxodotreotide treatment. One patient developed a serious gastrointestinal adverse event in the form of grade III nausea that developed after the first lutetium-(177Lu)-oxodotreotide dose. Subsequently, the woman and the 81-year-old patient died due to AML. The patient, who developed acute kidney injury, was hospitalised for treatment with IV fluids. Then, the patient recovered fully, and the patient continued to receive further PRRT with lutetium-(177Lu)-oxodotreotide, without any toxicity. The patient, who developed grade III nausea, was hospitalised for treatment with anti-emetics. The patient received subsequent lutetium-(177Lu)-oxodotreotide (PRRT) doses along with prophylactic antiemetics, without any recurrence of toxicity. Lim LE, et al. Australi