Summary: A new study shows peptide receptor radionuclide therapy (PRRT) is a safe and effective treatment option for advanced meningiomas, achieving a 57% disease control rate and offering hope for relapsed cases with minimal side effects.

Key Takeaways

  1. The study demonstrates peptide receptor radionuclide therapy (PRRT) as a safe and effective alternative treatment for advanced meningiomas, achieving a 57% disease control rate.
  2. PRRT may offer a viable option for patients with relapsed meningiomas, providing hope where other treatments are ineffective.
  3. By targeting somatostatin receptors (SSTR) in meningioma cells, PRRT achieves effective disease management with minimal side effects and favorable quality of life outcomes.

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Peptide receptor radionuclide therapy(PRRT)has been deemed a safe and effective alternative treatment for patients with advanced meningiomas, according to new research published in The Journal of Nuclear Medicine. PRRT resulted in a disease control rate of 57% and could represent a potential retreatment option for relapsed meningioma patients. 

Meningiomas are typically benign tumors that grow slowly; but on rare occasions, they can become cancerous and infiltrate nearby brain tissue. A meningioma—which can grow to be the size of a grapefruit—can cause seizures, numbness and/or weakness on one side of the body, nausea, persistent headaches, loss of neurological function, balance issues, muscle weakness, and hearing or vision loss.

New PRRT Therapy for Meningiomas

Surgery and radiation therapy are the most common treatments for meningiomas. If a patient has a recurrent or resistant meningioma, however, there are no treatment options to relieve their disabling neurological symptoms.

“Approximately 80% of meningioma cells overexpress somatostatin receptors (SSTR), which are an ideal target for PRRT,” says Alberto Bongiovanni, MD, oncologist at the IRCCS Istituto Romagnolo per lo studio dei Tumori, IRST, in Meldola, Italy. “Our study utilized a SSTR-based theranostic approach with 68Ga-DOTA PET/CT for diagnosis and beta-emitting radiopharmaceuticals for therapy and sought to determine its safety and effectiveness.”

Forty-two meningioma patients with recurrence after surgery and/or radiation therapy were included in the study. Over a mean of four cycles, five patients were treated with 90Y-DOTATOC (cumulative activity of 11.1 GBq), and 37 patients were treated with 177Lu-DOTATATE (cumulative activity of 22 GBq). Retreatment PRRT was performed in six patients with an administered median activity of 13 GBq in a mean of five cycles. All treated patients underwent 111In-octreostide and 68Ga-DOTATOC PET/CT imaging to evaluate tumor burden.

Extending Meningioma Survival

PRRT was well-tolerated among patients and showed a disease control rate of 57%. With a median follow-up of 63 months, the median progression-free survival was 16 months, and median overall survival was 36 months. For those receiving retreatment PRRT, the median follow-up was 75.8 months, with a median progression-free survival of 6.5 months, and a median overall survival of 17 months.

“This study represents the largest case series of patients with recurrent meningiomas treated with PRRT,” says Bongiovanni. “Results show that PRRT is a potential treatment option for this orphan disease and allows for effective disease control. The treatment has very few side effects and offers a good quality of life for those suffering from meningiomas.”

Featured image: (A) 68Ga-DOTATOC PET/CT–positive image of symptomatic patient who underwent 2 resections in 1990 and in 1992. (B) MRI from 2018 of same patient with recurrent and progressive meningioma, who also received radiotherapy (50 Gy/25 fractions) with neither disease nor symptom improvement. After multidisciplinary discussion, decision was made to include patient in our 177Lu protocol, and after 5 cycles of 177Lu-DOTATATE PRRT, patient obtained partial response with clinical improvement. 68Ga-DOTATOC PET/CT performed in 2022 (C) showed persistent positivity and partial response that was confirmed at last MRI on June 3, 2023 (D).