Abstract

Background: Carcinoids are slow-growing neuroendocrine tumors that can be found throughout the gastrointestinal tract and in other organs like the lungs and kidneys. These tumors are capable of metastasis and production of certain chemicals, e.g., serotonin that can cause carcinoid syndrome. Initial treatment is surgery; however, inoperable or metastatic carcinoid tumors can be treated with peptide receptor radionuclide therapy using [177Lu]Lu-DOTA-TATE which can provide symptomatic relief and also slows the disease progression.
Case presentation: We present here a case of gastrointestinal carcinoid in a 65-year-old male patient treated with indigenously produced [177Lu]Lu-DOTA-TATE. The patient presented 3 years after the resection of the intestinal mass and was on somatostatin analogues for control of flushing and diarrhea. Investigations revealed a focal lesion in the liver for which [177Lu]Lu-DOTA-TATE therapy was planned. The patient underwent four cycles of [177Lu]Lu-DOTA-TATE therapy with no undesirable side effects. Six months follow-up investigations after the completion of four cycles of [177Lu]Lu-DOTA-TATE therapy showed no interval progression and a better control of symptoms.
Conclusion: [177Lu]Lu-DOTA-TATE therapy is an effective but expensive treatment for patients having symptomatic disease and inoperable or progressive neuroendocrine tumors; that do not respond well to conventional treatments. Until recently, [177Lu] Lu-DOTA-TATE had to be imported for use in such patients which increased its cost even more. However, the initiative for the production of this radio-pharmaceutical in Pakistan has made it easier to acquire and also lowered the cost significantly.

Key words: PRRT, [177Lu]Lu-DOTA-TATE therapy, neuroendocrine tumors, small bowel carcinoid.