Peptide Receptor Radionuclide Therapy (PRRT) offers radiomolecular precision medicine for somatostatin receptor (SSTR)-positive advanced neuroendocrine neoplasms (NEN). In cases resistant to Lutetium-177-labeled DOTATATE or DOTATOC PRRT, alpha-therapy with Actinium-225 labeled with SSTR antagonists like DOTA-LM3 can be a notable therapeutic option. This retrospective study aimed to assess [225Ac]Ac-DOTA-LM3 safety in advanced NEN patients (as monotherapy and with Lutetium-177 as TANDEM), survival, and follow-up duration. Thirty-five patients received a total of 57 [225Ac]Ac-DOTA-LM3 cycles (March 2022–September 2024): 24 monotherapies and 33 TANDEM therapies. The pancreas was the most common primary site (n= 19). PRRT-related toxicity was assessed, focusing on hematological, renal, and hepatic toxicity (Common Terminology Criteria for Adverse Events—CTCAE v5.0). Therapy was generally well tolerated, with mostly mild acute adverse events (primarily nausea,n= 8). Some new grade 3/4 long-term adverse events were reported after treatment: anemia grade 3 (n= 2), leukocytopenia grade 4 (n= 1), absolute neutrophil count reduction grade 3 (n= 1), thrombocytopenia grade 3 (n= 7), acute myeloid leukemia (n= 1), nephrotoxicity grade 3 (n= 2), and hepatotoxicity grade 3 (n= 2). During follow-up, 13 patients died (survival range 5–30 months); 22 patients were alive (follow-up range 1–18 months). Our retrospective analysis shows that [225Ac]Ac-DOTA-LM3 PRRT is relatively safe concerning acute and long-term toxicity and bears promising survival outcomes in patients progressing after [177Lu]Lu-DOTATATE or [177Lu]Lu-DOTATOC PRRT.
肽受体放射性核素治疗（PRRT）为生长抑素受体阳性的晚期神经内分泌肿瘤提供了放射性分子精准医疗。对于镥-177标记的DOTATATE或DOTATOC PRRT治疗无效的病例，采用锕-225标记的SSTR拮抗剂（如DOTA-LM3）进行α治疗是一种重要的治疗选择。本研究旨在回顾性评估[225Ac]Ac-DOTA-LM3在晚期NEN患者中的安全性（包括单药治疗及与镥-177联合的TANDEM疗法）、生存期及随访时长。2022年3月至2024年9月期间，35例患者共接受57个周期的[225Ac]Ac-DOTA-LM3治疗：其中24例为单药治疗，33例为TANDEM治疗。胰腺是最常见的原发部位（n=19）。研究评估了PRRT相关毒性，重点关注血液学、肾脏和肝脏毒性（采用不良事件通用术语标准CTCAE v5.0）。治疗总体耐受性良好，急性不良事件多为轻度（主要为恶心，n=8）。治疗后报告了部分新发的3/4级长期不良事件：3级贫血（n=2）、4级白细胞减少（n=1）、3级中性粒细胞绝对值降低（n=1）、3级血小板减少（n=7）、急性髓系白血病（n=1）、3级肾毒性（n=2）和3级肝毒性（n=2）。随访期间，13例患者死亡（生存期5-30个月）；22例患者存活（随访期1-18个月）。我们的回顾性分析表明，对于[177Lu]Lu-DOTATATE或[177Lu]Lu-DOTATOC PRRT治疗后进展的患者，[225Ac]Ac-DOTA-LM3 PRRT在急性和长期毒性方面相对安全，且展现出良好的生存前景。
肿瘤(癌症)患者之家