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Background: Both everolimus and peptide receptor radionuclide therapy (PRRT) are approved as monotherapies for advanced neuroendocrine tumors (NETs). Research in animal models showed synergism between the two treatment modalities. This study aimed to evaluate the safety and efficacy of combining everolimus and PRRT in the treatment of unresectable NETs. Methods: Adult patients (≥18 years) with progressing and unresectable histologically confirmed grade 1-2 NETs of all origins were enrolled. Everolimus was started at a 5 mg daily dose and was increased after the initial three patients to 10 mg daily. Patients were treated concurrently with 177Lu-DOTATATE at an 8-week interval, with planned four cycles. Safety was the primary endpoint, with response rate and progression-free survival (PFS) being secondary. Results: Eleven patients were enrolled. The trial was terminated early for poor accrual. The median age was 51 years (18-64), and 4 were males. The median number of cycles of 177Lu-DOTATATE was 3, and the median cumulative dose was 300 mCi. The most frequent grade 1-2 toxicities were stomatitis (90.9%) and nausea (72.7%). Less frequent were fatigue (63.6%), anorexia, diarrhea, and skin changes (each at a 36.4% rate). Grade 3 toxicities occurred in 36% (fatigue, infection, pneumonitis, neutropenia, and stroke). No patient developed grade 4 toxicity. Treatment was stopped because of progression in three patients, and toxicity in another three patients, in addition, in four patients due to therapy interruption and in one patient who developed stroke. One patient achieved partial response, and nine had stable disease. One patient developed disease progression. At a median follow-up of 18.9 months, three died and one was lost to follow-up. The median PFS was 23.3 months. Conclusions: The combination of everolimus at a dose of 10 mg daily and 177Lu-DOTATATE appears not to be feasible. A larger trial at a lower dose of everolimus is warranted.
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BACKGROUND: There is variable cardiac uptake observed on oncological ¹8F-fludeoxyglucose ([¹8F]FDG) positron emission/computed tomography (PET/CT). The main purpose of this study is to evaluate patterns of overnight fasting myocardial [¹8F]FDG uptake in oncological PET/CT and analyse the relationship between myocardial [¹8F]FDG uptake and myocardial ischaemia on stress single-photon emission CT (SPECT) myocardial perfusion imaging (MPI). MATERIAL AND METHODS: A total of 362 subjects underwent both oncological PET/CT and stress SPECT MPI within 3 months of each other. Subjects with focal-mass-like [¹8F]FDG myocardial uptake raising the suspicion of cardiac metastasis and subjects with coronary artery disease (CAD) were excluded. The myocardial [18F]FDG uptake was classified into four patterns. RESULTS: Abnormal SPECT MPI was noted in 91 (25%) patients; 220 (61%) patients had completely absent [18F]FDG uptake, 80 (22%) had diffuse [¹8F]FDG uptake, 39 (11%) had focal on diffuse [¹8F]FDG uptake, and 23 (6%) had focal or regional myocardial [¹8F]FDG uptake, the regional [¹8F]FDG myocardial uptake was the most predictive of myocardial ischaemia on SPECT MPI, and there were positive associations between age, sex, hypertension, tobacco smoking, hypercholesterolemia, and left ventricular ejection, a fair agreement was noted between the focal or regional FDG uptake and presence of ischaemia on SPECT, K = 0.394 (95% CI 0.164 to 0.189). CONCLUSIONS: Based on the presented findings, the physiological myocardial [¹8F]FDG uptake in fasting oncology patients is variable. The regional myocardial [¹8F]FDG uptake pattern is the most frequent pattern associated with myocardial ischaemia on stress SPECT MPI, however, the agreement between regional FDG uptake and presence of ischaemia on SPECT is fair.
Asunto(s)
Enfermedad de la Arteria Coronaria , Isquemia Miocárdica , Imagen de Perfusión Miocárdica , Neoplasias , Fluorodesoxiglucosa F18 , Humanos , Isquemia Miocárdica/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
BACKGROUND: Cardiovascular disease (CVD) and osteoporosis are major health-care concerns worldwide. The evidence is contradictory on whether a relationship exists between low bone mineral density (BMD) determined by dual-energy absorptiometry (DXA scan) and coronary artery calcification (CAC) measured by computed tomography. Currently, there are no data on patients from Saudi Arabia. OBJECTIVE: Examine the relationship between CAC and BMD in both genders and study the influence of traditional coronary artery disease (CAD) risk factors and osteoporosis. DESIGN: Retrospective, cross-sectional, analytical. SETTING: Single tertiary care center. PATIENTS AND METHODS: We searched radiology databases for patients who underwent both DXA and CAC score scanning within six months of each other. The inclusion criterion was an absence of any history of CAD. MAIN OUTCOME MEASURE: Association between osteoporosis and CAC. SAMPLE SIZE: 195 (34 osteoporosic, 161 normal BMD or osteopenic) RESULTS: Most of the study population (57.4%) were females. The mean age of all patients was 63.6 (10.1) years. Participants with CAC scores of 0 were significantly younger than those who had CAC scores >0. The presence of diabetes mellitus, hypertension, and hypercholesterolemia was higher in patients with CAC scores >0. CAC score and other CAD risk factors were not significantly different between the osteoporotic and nonosteoporotic groups, except for body mass index. A high CAC score (>100) was present in 28%, 20%, 11%, and 30% of participants with no osteoporosis, osteoporosis of the lumbar spine, osteoporosis of the femoral neck, and participants with osteoporosis of both the lumbar spine and femoral neck, respectively (P=.762), suggesting there is no association between CAC and the presence of osteoporosis. CONCLUSIONS: Osteoporosis is not associated with higher CAC scores in Saudi Arabia and CAD risk factors are not significantly prevalent in osteoporosis. It appears that CAC and osteoporosis are independent age-related diseases that share common risk factors. LIMITATIONS: Single-center, retrospective. CONFLICT OF INTEREST: None.