Ho-166 Therapy Found Effective for Liver Metastases from Neuroendocrine Tumours

The Lancet Oncology reported a single-centre Dutch phase II clinical trial by Braat and colleagues, who showed that following Lutetium-177 (Lu-117) therapy, Holmium-166 (Ho-166)-based radioembolization, for neuroendocrine tumour liver metastases was effective in these patients.

Study Details

In the study, 31 patients enrolled at University Medical Center Utrecht between October 2014 and September 2018 received holmium Ho-166 radioembolization within 20 weeks after 4 treatments with lutetium Lu-177 dotatate. This radioembolization procedure required a 3-day hospital stay.

The primary endpoint the study aimed to measure was the objective liver tumour volume response at month 3.

Responses

• All 30 evaluable patients completed 6 months of follow-up.
• An objective response in liver tumour volume was observed in 13 of 30 patients (43%) at month 3 and in 14 (47%) at month 6.
• All responses were partial; 50% of patients had stable disease at month 3 and 37% at month 6.

Side Effects

Among the 31 patients who underwent radioembolization, the most common serious (grade 3 or 4) clinical and laboratory side effects within 6 months were abdominal pain (10%), increased γ-glutamyl transpeptidase (GGT) (54%) and lymphocytopenia (23%). One patient had fatal radioembolization-induced liver damage; in addition to this patient, two other patients had serious adverse events thought to be unrelated to treatment: a gastric ulcer and perforated cholecystitis.

In conclusion, [Holmium Ho-166] radioembolization in addition to peptide receptor radionuclide therapy (Lu-177) is safe and effective in patients with liver metastases from neuroendocrine cancer. Radioembolization may be considered, including after peptide receptor radionuclide therapy, in patients with large liver tumours. A future randomized, controlled clinical trial should investigate the additional benefit of this treatment for progression-free survival.