ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P838 | DOI: 10.1530/endoabs.63.P838

(131) I-MIBG therapy in metastatic paraganglioma and phaeochromocytoma: a 4-year single centre experience

Estefanía Santos Mazo1, Isabel Lanchas2, Miguel Begoña2, Javier Pi Barrio1, Guillermo Crespo3, Manuela Moreira4, Victor García-Hierro1 & Javier Sánchez Manuel5


1Endocrinology and Nutrition (University Hospital), Burgos, Spain; 2Nuclear Medicine (University Hospital), Burgos, Spain; 3Oncology (University Hospital), Burgos, Spain; 4Endocrinology and Nutrition (University Hospital), Palencia, Spain; 5Surgery (University Hospital), Burgos, Spain.


Retrospective study of patients with metastatic/progressive pheochromocytoma (PCC) and paraganglioma (PGL) treated with (131) I MIBG in our hospital during 2015–2018 period.

Methods: There are no established criteria for establishing PCC/PGL as malignant apart from de presence of metastases at diagnosis. Radionuclide therapy (131) I-metaiodobenzylguanidine (MIBG) is frequently used in this patients when surgery is not possible. Indication of MIBG treatment was made in the Neuroendocrine Tumor Multidisciplinary Team meeting. After a (123) I-MIBG to assess tracer uptake standard 200 mCi (131) I-MIBG dose was administered in each patient until disease stabilization and then follow up was made.

Results:

Paciente APaciente BPaciente C
DiagnosisPGL stage IVPCC stage IVPCC stage IV
Metastases at diagnosisliver, bone, peritoneum, mesenteric lymph nodesLungDiaphragm, liver, periadrenalectomy tissue, para aortic lymph node
Age585857
SexFemaleFemaleMale
Genetic testingNegativeNegativeNegative
Ki 671%--
Clinically functioning tumorMild hypertension FlushingBad controlled hypertensionBad controlled hypertension
Other treatments before I-MIBGSurgery 2009-2013 Temodal+Capecitabine 2015 (neutropenia)Surgery 1980Surgery 2004
Treatment cycles4 (Jan 2016-March 2017)4 (Sept 2015-Jan 2017)4 (Nov 2013-2014)+4 (Feb 2018-August 2018)
Before treatment Plasma Normetanephrine (N<180 pg/ml) Urine Normetanephirne (N<444 ug/24h)January 2016 -Plasma Normetanephrine 199 pg/ml -Urine Normetanephrine 1122 ug/24September 2015 -Plasma Normetanephrine 300 pg/ml -Urine Normetanephrine 1192ug/24 h2013 -Plasma Normetanephrine 788 (<444)
After last MIBG treatment (hormonal response)October 2018 -Plasma Normetanephrine 158 pg/ml -Urine Normetanephrine 614 ug/24 hNovember 2018 -Plasma Normetanephrine 2 213 pg/ml -Urine Normetanephrine 631 ug/24 h-
Clinical Response to treatmentLess frequent and intense hot flashes Well controlled hypertensionWell controlled hypertensionBetter control of hypertension
Radiological response (RECIST) to treatmentStable diseaseStable diseaseProgression liver metastases in 2014 Stable disease 2018
Metabolic response to treatmentStabilization or mild response in liver and mesentery. Metabolic response in boneStabilization or partial response (lung)Partial metabolic response in liver Stabilization para aortic lymph node
Free Progression Survival+36 months+40 months+45 months
Cumulative activity (MBq)800 mCi800 mCi1550 mCi
Haematological toxicityNoneNeutropenia grade2None
Renal toxicityNoneNoneNone

Conclusion: Therapy with (131) I-MIBG is a safe therapeutical option in patients with metastatic PCC/PGL, leading to easier control of hypertension, and mild improvement or at least stabilization of disease progression without major side effects in our 4 year centre experience.

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