Summary: Intraarterial peptide receptor radionuclide therapy (PRRT) has shown to be a safe and effective treatment for advanced meningioma, offering improved disease control compared to intravenous PRRT with minimal toxicity, according to a long-term study.

Key Takeaways

  • Enhanced Efficacy with Intraarterial PRRT: Intraarterial PRRT for advanced meningioma demonstrated significantly improved radiologic and clinical disease control (80%) compared to intravenous PRRT (40%), with no additional toxicity.
  • Feasibility and Safety: The study confirmed that intraarterial administration of radionuclide therapy is a safe and feasible treatment option, with only transient adverse effects observed.
  • Potential for Personalization: Researchers highlight the future potential of personalized dosing and combination therapies to enhance outcomes for patients ineligible for conventional treatments.

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Radionuclide therapy delivered directly to an artery is safe and feasible for patients with advanced meningioma, according to new research published in the December issue of The Journal of Nuclear Medicine. In the first long-term study of intraarterial peptide receptor radionuclide therapy (PRRT) in advanced meningioma, patients saw improved radiologic and clinical disease control compared with intravenous PRRT, with no additional toxicity. 

Radiopharmaceutical Therapy

Meningiomas are the most common primary neoplasms of the central nervous system and account for more than one-third of all cases. Meningiomas are mostly classified as benign, but 10%-15% of cases are considered atypical or malignant. The preferred treatment is surgery with external beam radiotherapy. However, 30%-40% of lesions are ineligible for surgery due to their location. Furthermore, recurrence rates are notably high.

“For meningioma patients who are ineligible for surgery or who experience tumor recurrence, treatment options are limited,” says Adriana Amerein, MD, nuclear medicine resident at University Hospital Augsburg in Germany. “Due to the high expression of somatostatin receptors in most meningiomas, radiopharmaceutical therapy offers a viable therapeutic alternative for patients. Intraarterial administration of the radiopharmaceutical might boost the achievable radiation dose to the tumor.”

In the study, researchers assessed the long-term safety and efficacy of intraarterial PRRT in patients with advanced, progressive meningioma. Thirteen patients underwent one to four cycles of intraarterial PRRT with 177Lu-HA-DOTATATE. Safety and treatment response was evaluated according to medical criteria, and results were compared with intravenous PRRT.

Future Potential

Treatment with intraarterial PRRT was well tolerated, with only transient adverse effects. The median progression-free survival for intraarterial PRRT was 18 months, and the median overall survival was not reached after 43 months. Approximately 80% of the patients showed radiologic disease control after intraarterial PRRT, compared to 40% after intravenous PRRT.

“These findings show that intraarterial administration of radiopharmaceutical therapy in meningioma is feasible, safe, and could be a promising therapeutic option in the future,” says Constantin Lapa, MD, nuclear medicine physician at University Hospital Augsburg. “Looking forward, personalized dosing and combination therapies utilizing intraarterial PRRT could further improve results for patients who don’t respond to conventional therapies.”

Featured image: Transaxial slices of baseline PET and fused PET/MRI (left) demonstrate a somatostatin receptor-expressing meningioma in the left cavernous sinus (white and black arrows). After four cycles of peptide receptor radionuclide therapy (PRRT), a complete remission according to the Response Assessment in Neuro-Oncology as well as PET criteria was recorded (right). Scale bars denote standardized uptake values.