Theranostic Approach Confirmed an Effective and Well-Tolerated Treatment Option for Recurrent Meningiomas

Reston, VA (October 30, 2024)—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 percent 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.

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 percent of meningioma cells overexpress somatostatin receptors (SSTR), which are an ideal target for PRRT,” said 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.

PRRT was well-tolerated among patients and showed a disease control rate of 57 percent. 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,” noted 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.”

Figure 5. (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).

The authors of “Peptide Receptor Radionuclide Therapy in Advanced Refractory Meningiomas: Efficacy and Toxicity in a Long Follow-up” include Stefano Severi, Ilaria Grassi, Silvia Nicolini, Irene Marini, Federica Matteucci, Giovanni Paganelli, and Maddalena Sansovini, Nuclear Medicine and Radiometabolic Units, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori,” Meldola, Italy; Alberto Bongiovanni, Nicoletta Ranallo, Lorena Gurrieri, and Nada Riva, Osteoncology and Rare Tumor Center, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Italy; Donatella Arpa and Lucia Fabbri, Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Emilia Romagna, Italy; Irene Azzali and Monti Manuela, Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Italy; Valentina Di Iorio, Oncological Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Emilia Romagna, Italy; Anna Sarnelli, Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Italy; Elena Amadori, Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Italy; Daniela Bartolini, Pathology Unit, “Maurizio Bufalini” Hospital, Cesena, Italy; Luigino Tosatto, Department of Neurosciences, Neurosurgery Division “M Bufalini” Hospital, Cesena, Emilia Romagna, Italy; Francesco Di Meco, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy, and Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and Luana Calabro, Department of Oncology, University Hospital of Ferrara, Cona, Italy, and Department of Translational Medicine, University of Ferrara, Ferrara, Italy.

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