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Background  Peptide receptor radionuclide therapy (PRRT) is an effective form of treatment for patients with metastatic neuroendocrine tumors (NETs). However, delivering sufficient radiation dose to the tumor to result in a high percentage of long-term tumor remissions remains challenging because of the limits imposed on administered activity levels by radiation damage to normal tissues. The goal of this study was to evaluate the dosimetric advantages of adding  131 I meta-iodobenzylguanidine ( 131 I-MIBG) to  90 Y DOTA Phe1-Tyr3-octreotide ( 90 Y-DOTATOC) in patients with advanced stage midgut NETs.    Methods  Ten patients were imaged simultaneously with  131 I-MIBG and  111 In-pentetreotide (as a surrogate for  90 Y-DOTATOC) on days 1, 2, and 3 post-administration. Blood samples were obtained at the same time points. Using dosimetry measures from this data and our previously published methodology for calculating optimal combined administered activity levels for therapy, we determined the amount of  131 I-MIBG that could be added to  90 Y-DOTATOC without exceeding normal organ dose limits (marrow and kidneys) along with the expected increase in associated tumor dose, if any.    Results  We found that a median value of 34.6 GBq of  131 I-MIBG could be safely added to  90 Y-DOTATOC (delivered over multiple cycles) by reducing the maximum total deliverable  90 Y-DOTATOC by a median value of 24.5%. Taking this treatment approach, we found that there would be a median increase in deliverable tumor dose of 4,046 cGy in six of the ten subjects. Of note, there were a small number of metastases that were positive for only one or the other of these radiopharmaceuticals within the same subject.    Conclusions  We conclude that approximately half of the patients with midgut NETs that are eligible for PRRT could reasonably be expected to benefit from the addition of  131 I-MIBG to  90 Y-DOTATOC.

Feasibility and advantage of adding 131I-MIBG to 90Y-DOTATOC for treatment of patients with advanced stage neuroendocrine tumors