Poster Presentation The Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2014

Peptide Receptor Chemo-Radionuclide Therapy is highly effective for intractable hypoglycaemia due to metastastic insulinoma (#276)

David A Pattison 1 2 , Michael S Hofman 1 3 , Grace Kong 1 , Tim Akhurst 1 , Sally Abell 4 5 , Bethany Crinall 4 5 , Nirupa Sachithanandan 2 3 , Cherie Chiang 2 3 , Rodney J Hicks 1 3
  1. Centre for Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
  2. Endocrinology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
  3. Department of Medicine, University of Melbourne, Parkville, VIC, Australia
  4. Diabetes & Vascular Unit, Monash Medical Centre, Clayton, VIC, Australia
  5. Monash Centre for Health Research and Implementation, School of Public and Preventive Medicine, Monash University, Clayton, VIC, Australia

Background: There are limited effective treatment options for metastatic insulinoma with intractable hypoglycaemia in which the cause of death is often hypoglycaemia rather than oncologic disease burden.

Methods: A retrospective audit identified six patients (3 men, age 55–77 years) with a diagnosis of metastatic insulinoma treated with peptide receptor chemo-radionuclide therapy (PRCRT) according to defined eligibility criteria for control of hypoglycaemia between July 2004 - June 2014 at the Peter MacCallum Cancer Centre. Five patients had prior inadequate response and/or intolerability of therapies including surgical-debulking, somatostatin-analogue therapy, diazoxide, glucocorticoids, glucagon, enteral feeding and cytotoxic chemotherapy; one patient was treated at diagnosis. Of patients with available tumour histology, three were ENETs Grade 1 (Ki,67 ≤2%) and one was Grade 2 (Ki,67 20%). All patients received 177Lu DOTA-octreotate (median cumulative dose 44.1 GBq) and radiosensitising 5FU chemotherapy; two patients also received either 111In DOTA-octreotide or 90Y DOTA-octreotate.

Results: All patients had complete resolution of hypoglycaemia after a median of 12 weeks (range 1–102 weeks) following treatment with PRCRT. Hyperglycaemic therapies were weaned and then ceased in all patients after a median of 4.5 weeks (range 1–14) and 32 weeks (range 1–128) respectively. Three patients were admitted for post-treatment flare of hypoglycaemia. Three patients had ongoing resolution of hypoglycaemia out to 35, 92 and 187 weeks follow-up. Recurrent hypoglycaemia occurred in three patients after 32, 77 and 222 weeks, and all were successfully re-treated with PRCRT. Median survival was not reached at median follow-up of 163 weeks. All patients demonstrated partial scintigraphic response to therapy and three of four patients with assessable lesions demonstrated partial response by RECIST criteria. Five patients with baseline elevated chromogranin A demonstrated a median reduction of 82% (range 51–94%) after PRCRT.

Conclusion: PRCRT is a highly effective therapy for relief of intractable hypoglycaemia in patients with metastatic insulinoma.