Quantitative SSTR-PET/CT for Predicting Response and Survival Outcomes in Patients with Pancreatic Neuroendocrine Tumors Receiving CAPTEM

Abstract

Rationale and objectives: This study aimed to evaluate the predictive and monitoring role of SSTR (somatostatin receptor) positron emission tomography–computed tomography (PET/CT) and clinical parameters in patients with liver metastases (NELM) from pancreatic neuroendocrine tumors (pNET) receiving capecitabine and temozolomide (CAPTEM).

Materials and methods: This retrospective study included twenty-two patients with pNET and NELM receiving CAPTEM who underwent pre- and post-therapeutic ⁶⁸Ga-DOTATATE/-TOC PET/CT. Imaging (including standardized uptake value (SUV) of target lesions (NELM and pNET), normal spleen and liver) and clinical (Chromogranin A (CgA),Ki-67) parameters were assessed. Treatment outcome was evaluated as response according to RECIST 1.1, progression free survival (PFS) and overall survival (OS).

Results: The median PFS (mPFS) was 7 months. Responders had a significantly longer mPFS compared to non-responders (10 vs. 4 months,p=0.022). Median OS (mOS) was 33 months (mOS: responders=80 months, non-responders=24 months,p=0.182). Baseline imaging showed higher SUV in responders, including absolute SUV, tumor-to-spleen (T/S), and tumor-to-liver (T/L) ratios (p<0.02). All SUV parameters changed only in the responders during follow-up. Univariable Cox regression analysis identified baseline Tmax/Smean ratio and percentage change in size of pNETs as significant factors associated with PFS. A baseline Tmax/Smean ratio<1.5 was associated with a shorter mPFS (10 vs. 4 months, (p<0.05)). Prognostic factors for OS included age, percentage change in CgA and in T/S ratios in univariable Cox regression.

Conclusion: SSTR-PET/CT is a tool for response and survival outcomes in pNET patients receiving CAPTEM: Higher baseline SUV values, particularly Tmax/Smean ratios were associated with better response and prolonged PFS.