High-Specific-Activity-I-MIBG versus Lu-DOTATATE Targeted Radionuclide Therapy for Metastatic Pheochromocytoma and Paraganglioma.

Abhishek Jha, David Taïeb, Jorge A Carrasquillo, Daniel A Pryma, Mayank Patel, Corina Millo, Wouter W de Herder, Jaydira Del Rivero, Joakim Crona, Barry L Shulkin, Irene Virgolini, Alice P Chen, Bhagwant R Mittal, Sandip Basu, Joseph S Dillon, Thomas A Hope, Carina Mari Aparici, Andrei H Iagaru, Rodney J Hicks, Anca M Avram, Jonathan R Strosberg, Ali Cahid Civelek, Frank I Lin, Neeta Pandit-Taskar, Karel Pacak

Journal: Clinical cancer research : an official journal of the American Association for Cancer Research 2022;27(11):2989-2995

PMID: 33685867

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Abstract

Targeted radionuclide therapies (TRT) using I-metaiodobenzylguanidine (I-MIBG) and peptide receptor radionuclide therapy (Lu or Y) represent several of the therapeutic options in the management of metastatic/inoperable pheochromocytoma/paraganglioma. Recently, high-specific-activity-I-MIBG therapy was approved by the FDA and both Lu-DOTATATE and I-MIBG therapy were recommended by the National Comprehensive Cancer Network guidelines for the treatment of metastatic pheochromocytoma/paraganglioma. However, a clinical dilemma often arises in the selection of TRT, especially when a patient can be treated with either type of therapy based on eligibility by MIBG and somatostatin receptor imaging. To address this problem, we assembled a group of international experts, including oncologists, endocrinologists, and nuclear medicine physicians, with substantial experience in treating neuroendocrine tumors with TRTs to develop consensus and provide expert recommendations and perspectives on how to select between these two therapeutic options for metastatic/inoperable pheochromocytoma/paraganglioma. This article aims to summarize the survival outcomes of the available TRTs; discuss personalized treatment strategies based on functional imaging scans; address practical issues, including regulatory approvals; and compare toxicities and risk factors across treatments. Furthermore, it discusses the emerging TRTs.

Address: Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland.; Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France.; Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York.; Department of Radiology, Weill Cornell Medical College, New York, New York.; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.; Department of Positron Emission Tomography, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland.; Section of Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, the Netherlands.; Developmental Therapeutics Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland.; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.; Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.; Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria.; Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland.; Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.; Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute, Mumbai, Maharashtra, India.; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa.; Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.; Divisions of Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine, Stanford, California.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.; Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan.; Division of Neuroendocrine Tumor/Department of Gastrointestinal Medicine, Moffitt Cancer Center, Tampa, Florida.; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, Maryland.; Molecular Imaging Program, NCI, NIH, Bethesda, Maryland.; Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York. [email protected] [email protected].; Department of Radiology, Weill Cornell Medical College, New York, New York.; Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland. [email protected] [email protected].

DOI: 10.1158/1078-0432.CCR-20-3703