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PubMed1992

Invasive mixed growth hormone/prolactin secreting pituitary tumour: complete shrinking by octreotide and bromocriptine, and lack of tumour growth relapse 20 months after octreotide withdrawal.

Octreotide and bromocriptine were used to treat an acromegalic patient harbouring an invasive pituitary tumour secreting growth hormone and prolactin. Octreotide (100 micrograms, subcutaneously, three times daily) and bromocriptine (15 mg orally, daily) rapidly improved clinical signs and symptoms, including diabetes that initially required insulin. Complete control of growth hormone and prolactin secretion was obtained and maintained by this treatment protocol for 12 months without affecting the other pituitary functions. A major tumour shrinkage was apparent by magnetic resonance imaging after six months, and was considered to be complete after 12 months of treatment. Octreotide was then discontinued without any relapse in either growth hormone secretion or tumour growth over a 20-month period following withdrawal. Attempts were made to discontinue bromocriptine, but a maintenance therapy (2.5 mg daily) was required to control rebounds of prolactin hypersecretion. Two months after octreotide withdrawal, acute pancreatitis secondary to cholelithiasis required surgery; this complication was attributed to octreotide (pre-treatment ultrasonography was normal). These findings suggest that combination therapy with octreotide and bromocriptine may be considered in pituitary macroadenomas secreting growth hormone and prolactin. They also emphasize the need for a close monitoring of cholelithiasis, not only during octreotide therapy but also after the drug's withdrawal.

Adenoma↗
PubMed2004

[Determination of octreotide in human plasma by HPLC-MS with solid-phase extraction and study on the relative bioavailability of domestic and imported octreotide injections].

AIM: To establish an HPLC-MS method for determination of octreotide in plasma and study the relative bioavailability of domestic and imported octreotide injections. METHODS: Octreotide in plasma samples were extracted with a Waters solid-phase extraction mini column. HPLC-MS was carried out using a Waters Xetrra C18 column and a mobile phase consisting of CH3 OH-1% HAc (80 : 20), the flow rate was 0.2 mL x min(-1), and the internal standard was 6, 7, 4'-OH-isoflavone, the SIR ions for quantification were m/z 1 014.4 for octreotide and m/z 317.6 for internal standard. A single dose of 200 microg of domestic or imported preparations was intramuscularly given to 18 healthy volunteers in a randomized crossover study. Octreotide concentration in plasma was determined by LC-MS method. The pharmacokinetics and bioavailability were studied. RESULTS: The regressive curve was linear (r = 0.9997) within the range of 0.5 - 40 microg x L(-1) for octreotide. The pharmacokinetics parameters of domestic and imported injection were reply to one compartment model. The mean C(max) were (19 +/- 10) microg x L(-1) and (19 +/- 11) microg x L(-1), T(max) were (0.50 +/- 0.15) h and (0.52 +/- 0.20) h, T1/2 were (1.5 +/- 0.8) h and (1.5 +/- 0.8) h, AUC(0-7 h) were (50 +/- 25) h x microg x L(-1) and (50 +/- 25) h x microg x L(-1), respectively. The relative bioavailability of domestic to imported injection was 101% +/- 10%. CONCLUSION: The method is accurat and sensible for assay of plasma octreotide concentration. The results of statistics showed the two preparations were bioequivalent.

Area Under Curve↗
PubMed1998

Somatostatin receptor subtypes, octreotide scintigraphy, and clinical response to octreotide treatment in patients with neuroendocrine tumors.

Several types of neuroendocrine tumor express high numbers of somatostatin receptors (sstr). We have compared the expression of sstr subtypes with the outcome of octreotide scintigraphy in patients with carcinoids and medullary thyroid carcinoma (MTC) in comparison with Hürthle cell tumors. The effect of sstr activation (octreotide treatment) on tumor markers was also studied in patients with disseminated carcinoid tumors. Six patients with carcinoid tumors (four midgut and two foregut), and three patients with thyroid tumors (one MTC, one Hürthle cell carcinoma, and one Hürthle cell adenoma) were studied. Octreotide scintigraphy visualized tumor sites in all nine patients. Macroscopic tumor was verified at these sites at subsequent surgical exploration. Using Northern blotting and subtype-specific riboprobes, sstr could be detected in all tumors examined. All five sstr subtypes were detected in most of the carcinoid tumors. All six carcinoids expressed sstr2. This was in contrast to the findings for the thyroid tumors analyzed, which also expressed several sstr subtypes but in some cases lacked expression of sstr2. This was also the case for normal thyroid tissue. Clinically, octreotide treatment of the patients with midgut carcinoid tumors resulted in palliation of hormonal symptoms accompanied by a significant reduction of urinary 5-HIAA levels (28-71%). These results indicate that carcinoid tumors frequently express all five sstr subtypes. The thyroid tumors also expressed multiple sstr but could lack expression of sstr2. Nevertheless, these tumors were visualized by octreotide scintigraphy, indicating that sstr2 expression is not a prerequisite for tumor imaging.

Adenocarcinoma↗
PubMed2000

LDL physical properties, lipoprotein and Lp(a) levels in acromegalic patients. Effects of octreotide therapy. Italian Multicenter Octreotide Study Group.

High vascular morbidity and mortality is associated with acromegaly. The aim of the present study was to assess the effects of octreotide therapy on several known cardiovascular risk factors and to correlate them with octreotide-induced hormonal changes. Lipid levels, LDL particle size distribution as evaluated by single vertical spin density gradient ultracentrifugation, apolipoproteins AI and B, lipoprotein (a) [Lp(a)] concentrations and apo(a) phenotypes were evaluated in 20 non-diabetic acromegalic patients (6 M, 14 F), with normal thyroid, adrenal and gonadal function, aged 29-66 years. Normal subjects (20), matched for age, sex and BMI served as control for lipid variables. Acromegalic patients were characterized by lower HDL cholesterol (and apoA-I) and by higher Lp(a) concentrations in comparison to controls. Treatment with octreotide (100 microg t.i.d. for 3 months) led to: an increase in HDL cholesterol (median: + 22%), a decrease in LDL cholesterol (-14%) and a decrease of the Lp(a) levels (all phenotypes) (-28%). The expected decreases of IGF-I levels (median: -48%) and 7-h AUC of GH (-50%), insulin (-40%) and glucagon (-20%) were observed. Only Lp(a) modifications showed a correlation with GH modifications. The study of LDL physical properties showed that acromegalic patients had smaller and/or more dense LDL particles, in comparison with normal controls (relative flotation rate, Rf: 0.40 +/- 0.03 versus 0.42 +/- 0.02 P < 0q05), an alteration that might contribute to the high vascular risk of acromegalic patients. However, the LDL subfraction distribution remained unmodified during octreotide therapy (Rf 0.39 +/- 0.03). In conclusion, this study shows that in acromegalic patients octreotide treatment is indeed associated with an amelioration of some lipoprotein parameters, i.e. LDL, HDL, and Lp(a) concentrations. However, this treatment has no effect on the small and/or dense LDL particles present in these patients.

Acromegaly↗
PubMed1997

A prospective multicenter trial of octreotide in 24 patients with visual defects caused by nonfunctioning and gonadotropin-secreting pituitary adenomas. French Multicenter Octreotide Study Group.

OBJECTIVE: The somatostatin analog octreotide has been demonstrated to improve optic tract compression caused by pituitary macroadenomas within hours of its administration and/or reduce tumor size in some patients. We report the results of a prospective multicenter study of the effects of octreotide on visual function and tumor size in patients with nonfunctioning pituitary adenomas or gonadotropin-secreting adenomas. METHODS: Twenty-four patients with visual defects caused by histologically confirmed macroadenomas were administered octreotide via continuous subcutaneous infusion, as follows: 100 micrograms the 1st day and, if necessary, 200 micrograms the 2nd and then 100 or 200 micrograms three times daily if visual function improved. Vision was assessed after 4 days, 1 month, and 2 months, including tumor size evaluation. Visual improvement was defined by a net gain of at least 2/10 in acuity and/or of more than 20% of the surface of one isopter (a reduction in tumor volume of > or = 20% of the initial measurement); opposite changes were defined as deterioration. RESULTS: Visual improvement was noted in 13 of 24 patients, 10 of 23 patients and 9 of 22 patients, and was not noted in 11 of 24 patients, 14 of 23 patients, and 13 of 22 patients after 4 days, 1 month, and 2 months, respectively. After 2 months, three adenomas had shrunk, three had not changed in size, and one had increased; visual function improved in the seven patients with these adenomas. Octreotide was discontinued in 13 patients for lack of efficacy. CONCLUSION: The incidence of visual improvement and tumor shrinkage noted in this study was higher than previously reported. Our data suggest that early onset of visual improvement might help in deciding which patients profit from octreotide. However, concomitant gain in visual acuity with deterioration in visual fields or visual improvement with an increase (moderate) in tumor size can occur.

Adenoma↗
PubMed1994

Octreotide in the treatment of acute pancreatitis: results of a unicenter prospective trial with three different octreotide dosages.

Acute necrotizing pancreatitis is still associated with high morbidity and mortality. In this prospective clinical trial, we analyzed the effect of octreotide in patients with acute pancreatitis. Eight patients received either 3 x 100, 3 x 200 or 3 x 500 micrograms octreotide subcutaneously per day over a period of 10 days. The complication rate was lower in the group of patients who received 3 x 200 or 3 x 500 micrograms octreotide than in the control group and the group of patients who received the dosis of 3 x 100 micrograms octreotide per day. The results of this study are promising and must be validated in a controlled clinical trial with octreotide in a larger patient population.

Acute Disease↗
PubMed2000

99mTc-HYNIC-[Tyr3]-octreotide for imaging somatostatin-receptor-positive tumors: preclinical evaluation and comparison with 111In-octreotide.

UNLABELLED: In this paper we describe the preclinical evaluation of 99mTc-hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC) using different coligands for radiolabeling and a comparison of their in vitro and in vivo properties with 111In-diethylenetriaminepentaacetic acid (DTPA)-octreotide. METHODS: HYNIC-TOC was radiolabeled at high specific activities using tricine, ethylenediaminediacetic acid (EDDA), and tricine-nicotinic acid as coligand systems. Receptor binding was tested using AR42J rat pancreatic tumor cell membranes. Internalization and protein binding studies were performed, and biodistribution and tumor uptake were determined in AR42J tumor-bearing nude mice. RESULTS: All 99mTc-labeled HYNIC peptides showed retained somatostatin-receptor binding affinities (Kd < 2.65 nM). Protein binding and internalization rates were dependent on the coligand used. Specific tumor uptake between 5.8 and 9.6 percentage injected dose per gram (%ID/g) was found for the 99mTc-labeled peptides, compared with 4.3 %ID/g for 111In-DTPA-octreotide. Tricine as coligand showed higher activity levels in muscle, blood, and liver, whereas tricine-nicotinic acid produced significant levels of activity in the gastrointestinal tract. EDDA showed the most promising overall biodistribution profile, with tumor-to-liver and tumor-to-gastrointestinal tract ratios similar to those obtained with 111In-DTPA-octreotide, lower ratios in blood and muscle, but considerably higher tumor-to-kidney ratios. CONCLUSION: TOC can be radiolabeled to high specific activities using HYNIC as a bifunctional chelator. The high specific tumor uptake, rapid blood clearance, and predominantly renal excretion make 99mTc-EDDA-HYNIC-TOC a promising candidate for an alternative to 111In-DTPA-octreotide for tumor imaging.

Animals↗
PubMed1991

Continuous subcutaneous octreotide infusion: dose-response relationships between metabolic effects and octreotide clearance in patients with insulin-dependent (type 1) diabetes.

Octreotide (Sandostatin), a potent and long-acting octapeptide analogue of somatostatin, exhibits variable metabolic effects in type 1 diabetes. We have postulated that interindividual variability in octreotide metabolism could be responsible in part for the differences in metabolic responses reported in previous clinical studies. To this end, we determined plasma levels and MCR of octreotide during 24-hour continuous SC infusion (low dose, 200 micrograms; high dose, 400 micrograms) in nine female, C peptide-negative patients with type 1 diabetes. The metabolic effects of the analogue were assessed by measuring serum glucose, free insulin, glucagon, GH, and PP levels before and at 1- to 2-hour intervals during each dose of the analogue or control (0.9% saline solution) infusion in a single-blind randomized manner. Mean daytime (0800-0000 hours) and bedtime (0000-0800 hours) serum glucose levels decreased significantly (p less than 0.05 to 0.02) during analogue therapy compared with control. Mean serum free insulin levels were significantly (p less than 0.02) greater during octreotide infusion compared with control, despite the similar daily insulin requirements. Both doses of the analogue effectively suppressed 24-hour GH by 50%, glucagon by 50%, and PP by 80%. Steady-state octreotide levels varied considerably among patients (low, mean +/- SEM), 1000 +/- 101, range 638 to 1375 pg/ml; high, mean 1940 +/- 147, range 1032 to 2462 pg/ml). Although mean MCR values were similar with both doses, we observed greater interindividual variability (low, mean 2.45 +/- 0.30, range 1.31 to 3.78 ml/kg/min; high, mean 2.36 +/- 0.19, range 1.68 to 3.48 ml/kg/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1995

111In-octreotide scintigraphy in metastatic medullary thyroid carcinoma before and after octreotide therapy: in vivo evidence of the possible down-regulation of somatostatin receptors.

We have investigated the presence of somatostatin receptors on the cell surface of metastatic medullary thyroid carcinoma in vivo using 111In-Octreotide scintigraphy. Five patients were studied before and three months after therapy with octreotide (300-600 micrograms/day). After each 111In-Octreotide scintigraphy the target/background (T/B) radioactivity ratio was calculated for each detectable metastases. A total of 14/18 metastases showed a reduction in the T/B ratio after therapy, suggesting saturation or down-regulation of the somatostatin receptors on metastases induced by octreotide therapy. Patients also showed a reduction in serum calcitonin levels after therapy. We conclude that 111In-Octreotide scintigraphy may be useful in medullary thyroid carcinoma to evaluate the rationale for somatostatin therapy and to monitor the effect of treatment.

Adult↗
PubMedDate not supplied

[111In-DTPA-D-Phe1]-octreotide scintigraphy in patients with hormone-refractory prostatic adenocarcinoma can predict therapy outcome with octreotide treatment: a pilot study.

A pilot study to evaluate the predictive value of Indium-111-labelled somatostatin analogue [DTPA-D-Phe1]-octreotide scintigraphy (OctreoScan111) in the Octreotide treatment of hormone-refractory prostatic adenocarcinoma was initiated. Ten patients were investigated with OctreoScan111 with regard to disease extension and tumor-to-background ratio. Subsequently, the patients were treated with Octreotide (Sandoz, Basel, Schweiz) at a dose of 100 micrograms twice a day subcutaneously. Three patients experienced symptomatic relief, and two of these responded with a decrease in PSA. Three patients did not notice any difference after 6 months of treatment and two of them developed an increase in their PSA value. One patient progressed after five months as regards both PSA and symptoms. Three patients were not able to complete treatment. Of the seven evaluable patients, the three with the highest tumour-to-background ratios at OctreoScan111 were those patients with reduced or stable PSA levels, and none of these progressed during treatment. Previous reports along with this study demonstrate that only a minority of patients with hormone-refractory prostatic adenocarcinoma benefit from Octreotide treatment. However, OctreoScan111 investigations may identify patients who will respond to Octreotide therapy.

Adenocarcinoma↗
PubMedDate not supplied

Distribution and elimination characteristics of 111In-DTPA-D-phe1-octreotide and 111In-DTPA-L-phe1-octreotide in rats.

The present study compares distribution and elimination characteristics of 111In-DTPA-D-Phe1-octreotide and 111In-DTPA-L-Phe1-octreotide in rats and evaluated the effect of the replacement of the terminal L-phenylalanine by D-phenylalanine on pharmacokinetic profiles of the radiolabelled peptides. Both agents exhibited rapid radioactivity clearance from the blood and most organs and tissues with no systematic and significant differences in activity accumulation. The long-term retention and high radioactivity concentrations for both compounds under study were found in the kidneys and organs with a high density of somatostatin receptors, such as the pancreas and adrenals. The residence times in these organs were longer for 111In-DTPA-D-Phe1-octreotide in comparison with 111In-DTPA-L-Phe1-octreotide. The major elimination pathway for both radiolabelled peptides was relatively rapid excretion into the urine. Analysis of the renal handling by an employment of the perfused rat kidney showed that both peptides were eliminated mainly by the mechanism of glomerular filtration. Rat liver perfusion experiments confirmed a very low value of bile clearance of radioactivity for both agents under study.

Animals↗
PubMed1998

Direct synthesis of [DOTA-DPhe1]-octreotide and [DOTA-DPhe1,Tyr3]-octreotide (SMT487): two conjugates for systemic delivery of radiotherapeutical nuclides to somatostatin receptor positive tumors in man.

Direct attachment of unprotected DOTA (1,4,7,10-tetraazacyclododecane-N',N",N"',N""-tetraacetic acid) to partially suitably protected octreotide or [Tyr3]-octreotide leads after deprotection to [DOTA-DPhe1]-octreotide (III) and [DOTA-DPhe1,Tyr3]-octreotide (IV). These DOTA-containing somatostatin analogs, when labeled with a radiotherapeutic nuclide, are useful as antitumor agents. The partially protected peptides are accessible via solid phase peptide synthesis (SPPS) followed by selective cleavage under mild acidic conditions from the resin.

Drug Carriers↗
PubMed1998

Comparative studies on the expression of somatostatin receptor subtypes, outcome of octreotide scintigraphy and response to octreotide treatment in patients with carcinoid tumours.

We have compared the expression of somatostatin receptor (sstr) subtypes with the outcome of somatostatin receptor scintigraphy and the effect of somatostatin receptor activation in patients with disseminated carcinoid tumours. Tumour tissues from nine patients with midgut carcinoids (ileal) and three patients with foregut carcinoids (gastric, thymic) were analysed using Northern blotting. Expression of somatostatin receptors was demonstrated in all tumours (12 out of 12), with all five receptor subtypes present in 9 out of 12 tumours. Somatostatin receptor scintigraphy using [111In]DTPA-D-Phe1-octreotide visualized tumours in all patients (12 out of 12). The 111In activity concentrations in tumour tissue (T) and blood (B) were determined in three tumours 1-7 days after injection of the radionuclide. The T/B 111In activity concentration ratios ranged between 32 and 651. Clinically, treatment with the long-acting somatostatin analogue octreotide resulted in marked symptom relief accompanied by a significant reduction in tumour markers, for example urinary-5-HIAA levels (28-71% reduction). Incubation of midgut carcinoid tumours in primary culture with octreotide (10 microM) resulted in a reduction in spontaneously secreted serotonin (45-71% reduction) and 5-HIAA (41-94% reduction). The results demonstrate that carcinoid tumours possess multiple somatostatin receptor subtypes and that somatostatin analogues such as octreotide, which preferentially bind to somatostatin receptor subtype 2 and 5, can be used in the diagnosis and medical treatment of these tumours. In the future, novel somatostatin analogues with subtype specific receptor profiles may prove to be of value for individualizing the treatment of disseminated carcinoid tumour disease.

Aged↗
PubMed1996

Graves' dermopathy: does octreotide scintigraphy predict the response to octreotide treatment?

We report on three patients with severe Graves' dermopathy who were treated with octreotide despite a negative octreotide scintigraphy. One patient showed a complete recovery while two others had a partial response. In contrast to active Graves' ophthalmopathy, an octreotide scintigraphy appears not to be useful for pretreatment identification of patients with Graves' dermopathy who are likely to respond to octreotide treatment.

Adult↗
PubMed2001

[Comparison between integrated 24-hour concentrations of growth hormone, insulin-like growth factor I and prolactin in acromegalic patients treated with octreotide and patients treated with octreotide LAR].

The current therapeutic options for acromegalic patients (surgery, radiation therapy and/or pharmacological treatment) do not always lead to a definitive resolution of the disorder. Recently, octreotide (OC) and, more recently, octreotide LAR (OC-LAR), a new slow-release formulation of the long-acting somatostatin analog, have been regarded as the primary treatment for acromegaly. This study reports our observations of the integrated 24-hour concentrations of GH, IGF-I and prolactin (PRL) in acromegalic patients treated with octreotide (OC) and octreotide LAR (OC-LAR), highlighting lower percentages of apparent remissions.

Acromegaly↗
PubMed1993

Hepatobiliary handling of iodine-125-Tyr3-octreotide and indium-111-DTPA-D-Phe1-octreotide by isolated perfused rat liver.

Radiolabeled bioactive peptides may show receptor-mediated binding to tumors, making them suitable for scintigraphic imaging. The liver is an important organ for peptide clearance. To gain insight into the uptake and intracellular processing of somatostatin analogs, we compared the hepatobiliary handling of 125I-Tyr3-octreotide and 111In-DTPA-D-Phe1-octreotide, which are successfully used to image somatostatin receptor-positive tumors in vivo in isolated recirculating perfused rat livers. Sixty minutes following administration of the radiolabeled peptides, perfusion medium and biliary radioactivity were analyzed. Radioiodinated Tyr3-octreotide was rapidly cleared by the liver and 60% of the dose was excreted intact into the bile after 60 min. In contrast, 111In-DTPA-D-Phe1-octreotide was not cleared by the liver; medium radioactivity levels remained about constant and only 2% of the dose was found in the bile. These results are in agreement with in vivo findings in rats and humans. We concluded that isolated rat liver perfusion is a good system to rapidly gain insight into the hepatic handling of radiopharmaceuticals.

Animals↗
PubMed1997

D-lysine reduction of indium-111 octreotide and yttrium-90 octreotide renal uptake.

UNLABELLED: Indium-111-DTPA-octreotide (111In-DTPAOC) is used successfully for imaging somatostatin receptor-positive lesions. A new and promising application is its use in peptide-receptor radionuclide therapy (PRRT). For the latter purpose, [DOTA0,D-Phe1,Tyr3]octreotide (DOTATOC), which is suitable for stable radiolabeling with 90Y, is probably even more promising. Significant renal uptake of these octreotide analogs exists, however, reducing the scintigraphic sensitivity for detection of small tumors in the perirenal region and limiting the possibilities for PRRT. We showed that the renal uptake of 111In-DTPAOC could be reduced to about 50% of control by L-lysine administration in vivo in rats. This study compares the effects of several doses and different methods of administration of D- and L-lysine, in addition to time-related effects of D-lysine, on kidney uptake of 111In-DTPAOC and 90Y-DOTATOC. METHODS: Male Wistar rats (200-250 g) were given 111In-DTPAOC (0.2 MBq, 0.5 microg-0.5 mg intravenously, intraperitoneally or orally) in the presence or absence of D- or L-lysine. At 1, 4 or 24 hr, the rats were killed, and the organs were isolated and counted for radioactivity. In different experiments, male Wistar rats (200-250 g) were given 90Y-DOTATOC (1 MBq, 0.5 microg intravenously) in the presence or absence of D-lysine. At 24 hr, the rats were killed, and the organs were isolated and counted for radioactivity. RESULTS: Administration of D- or L-lysine in a single intravenous dose of 400 mg/kg, resulted in more than 50% inhibition of kidney uptake of 111In-DTPAOC at all time points tested, independently of the mass of 111In-DTPAOC used. Higher or repeated doses of lysine did not give a significantly higher percentage inhibition. D-lysine, given orally in a dose of 400 mg/kg at 30 or 15 min before 111In-DTPAOC injection, resulted in 30% and 20% inhibition of kidney uptake, respectively. L-lysine, given orally 30 min before 111In-DTPAOC administration, resulted in 30% inhibition as well. Inhibition of kidney uptake of 111In-DTPAOC by L-lysine after intraperitoneal administration was 40%. After L-lysine administration, 111In-DTPAOC was decreased in the kidneys and in somatostatin receptor-positive organs such as the pancreas and adrenal glands. In contrast, D-lysine did not have a significant effect on uptake in octreotide receptor-positive organs. Renal uptake of 90Y-DOTATOC was reduced by 65% by intravenous D-lysine, whereas radioactivity in blood, pancreas and adrenal glands was not affected. CONCLUSION: D-lysine may be preferred to L-lysine for reduction of renal uptake of radioactivity during scintigraphy and PRRT because of its lower toxicity and because it should not interfere with the natural amino acid metabolic balance.

Animals↗
PubMed2000

Detection of somatostatin receptor-positive tumours using the new 99mTc-tricine-HYNIC-D-Phe1-Tyr3-octreotide: first results in patients and comparison with 111In-DTPA-D-Phe1-octreotide.

Indium- 111 labelled DTPA-D-Phe1-octreotide (DTPA-OC, OctreoScan) has been introduced into clinical routine for the detection of somatostatin receptor (SSTR)-positive tumours, which are predominantly of neuroendocrine origin. Potential further applications in other SSTR-positive cancers (e.g. small cell lung cancer, breast cancer, melanoma) have been limited mainly by the restricted availability and the high radionuclide costs. Previous attempts to introduce technetium-99m labelled analogues of octreotide have not been very successful in terms of the labelling procedure, in vivo biodistribution and/or tumour detection capabilities. The aim of this study was to assess the performance of the new 99mTc-labelled analogue HYNIC-D-Phe1-Tyr3-octreotide (HYNIC-TOC), using tricine as co-ligand, for the detection of SSTR-positive tumours in patients in comparison with 111In-DTPA-OC. Overall, 13 patients were examined using 99mTc-tricine-HYNIC-TOC. Twelve patients had proven SSTR-positive tumours, while one patient presented with an SSTR-negative tumour. In 9 of the 13 patients both tracers (99mTc-tricine-HYNIC-TOC and 111In-DTPA-OC) were used. Serial whole-body scans, spot views and/or single-photon emission tomography studies were performed. Images were qualitatively and semi-quantitatively (ROI analyses) evaluated. The biodistribution of 99mTc-tricine-HYNIC-TOC in patients showed high physiological uptake in kidneys, moderate uptake in liver and spleen and little uptake in the gut. The tracer showed predominantly renal and negligible hepatobiliary excretion. Known SSTR-positive tumour sites showed rapid and intense tracer accumulation. 99mTc-tricine-HYNIC-TOC demonstrated rapid tissue uptake within the first hour after injection and had basically no significant clearance (<20%) from normal or tumour tissue thereafter. In contrast, 111In-DTPA-OC showed continuous clearance from normal tissues as well as renal and very little hepatobiliary excretion. Nevertheless, the patterns of accumulation of 99mTc-tricine-HYNIC-TOC in tumours and normal organs were comparable to those of 111In-DTPA-OC. A lesion-by-lesion comparison showed comparable tumour detection capabilities in intrahepatic tumour sites and superior capabilities of 99mTc-tricine-HYNIC-TOC in respect of extrahepatic lesions. In conclusion, 99mTc-tricine-HYNIC-TOC shows promise as a tracer for SSTR imaging, given its favourable clinical characteristics (specific and high receptor affinity, good biodistribution, renal excretion, low radiation exposure, high imaging quality, on-demand availability) and cost-effectiveness. 99mTc-tricine-HYNIC-TOC allows earlier diagnosis (10 min-4 h) compared with 111In-DTPA-OC (4-24 h).

Adult↗