Prevention and management of carcinoid crises in patients with high-risk neuroendocrine tumours undergoing peptide receptor radionuclide therapy (PRRT): Literature review and case series from two Australian tertiary medical institutions

Gonzalo Tapia Rico; Minmin Li; Nick Pavlakis; Gabrielle Cehic; Timothy J Price

doi:10.1016/j.ctrv.2018.03.002

Prevention and management of carcinoid crises in patients with high-risk neuroendocrine tumours undergoing peptide receptor radionuclide therapy (PRRT): Literature review and case series from two Australian tertiary medical institutions

Cancer Treat Rev. 2018 May:66:1-6. doi: 10.1016/j.ctrv.2018.03.002. Epub 2018 Mar 16.

Authors

Gonzalo Tapia Rico¹, Minmin Li², Nick Pavlakis², Gabrielle Cehic³, Timothy J Price⁴

Affiliations

¹ Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
² Department of Medical Oncology, Royal North Shore Hospital, University of New South Wales, Australia.
³ Department of Nuclear Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
⁴ Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia. Electronic address: Timothy.Price@sa.gov.au.

PMID: 29602040
DOI: 10.1016/j.ctrv.2018.03.002

Abstract

Peptide receptor radionuclide therapy (PRRT) is an important therapeutic option for somatostatin receptor (SSTR) positive metastatic and/or inoperable neuroendocrine tumours (NETs). However, in patients with poorly controlled carcinoid syndrome, it may lead to an acute flare of carcinoid symptoms or even carcinoid crisis. We report seven patients who received PRRT with (¹⁷⁷Lu-DOTA⁰, Tyr³) octreotate (¹⁷⁷Lu-octreotate-LuTate) across two Australian tertiary medical institutions who developed acute flare of carcinoid symptoms/carcinoid crisis during/after PRRT. Cases were identified as high-risk due to previous history of carcinoid crises, high tumour burden and markedly elevated tumour markers. We propose a protocol to prevent and manage severe carcinoid symptoms in high-risk patients treated with PRRT.

Keywords: Carcinoid crisis; Neuroendocrine tumours; Octreotide; Premedication; Radionuclide therapy.

Publication types

Case Reports
Review

MeSH terms

Australia
Carcinoid Tumor / prevention & control*
Female
Humans
Male
Neuroendocrine Tumors / drug therapy*
Radiopharmaceuticals / pharmacology
Radiopharmaceuticals / therapeutic use*
Tertiary Care Centers

Substances

Radiopharmaceuticals