The therapeutic efficacy of 225Ac-DOTATATE in neuroendocrine tumors: a preliminary meta-analysis

Jiao MaYang JiZhihan YaoJiangchu YangqingChunyin Zhang^*

• Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Lu Zhou, China

Objective:This meta-analysis aims to evaluate the therapeutic efficacy and toxicity of 225Ac-DOTATATE in patients with metastatic neuroendocrine tumors (NETs). Methods: This systematic review adheres to the PRISMA guidelines. PubMed and Embase were searched to identify studies that met the inclusion criteria. The primary endpoints were the evaluation of therapeutic efficacy through disease response rates (DRRs) and disease control rates (DCRs), then assess the toxicity.Additionally, a subgroup analysis was 2 performed to evaluate the influence of prior 177Lu-peptide receptor radionuclide therapy (PRRT) on the efficacy. Results: This meta-analysis included 5 studies involving a total of 153 patients. The results showed that the DRRs following 225Ac-DOTATATE treatment were 52% (95% CI: 43%–61%), and the DCRs were 88% (95% CI: 81%–94%). The incidence of hematological toxicity was low at 2% (95% CI: 0.00%–5%), with only two patients experiencing Grade I-II renal toxicity, and no Grade III-IV toxicities were observed. Subgroup analysis indicated that patients who had previously received 177Lu-PRRT treatment had DRRs of 51% (95% CI: 35%–66%) and DCRs of 90% (95% CI: 69%–100%), while 177Lu-naive patients had DRRs of 47% (95% CI: 1%–97%) and DCRs of 89% (95% CI:72%–100%). Conclusion:Our preliminary analysis shows that 225Ac-DOTATATE is an effective and safe treatment option for advanced metastatic NETs, significantly improving patients' quality of life and demonstrating considerable disease control even in cases where other treatments have failed.