News in brief: ‘Milestone’ for PRRT in neuroendocrine tumours; Prostate cancer concerns after fall in PSA testing; Study aims to cut paediatric cancer infections

19 Nov 2021

‘Milestone’ for PRRT in neuroendocrine tumours

The first prospective, long-term, controlled trial of a radiopharmaceutical in neuroendocrine tumours (NET) has been described as a’milestone’ for showing clinically relevant improvement in median overall survival of 11·7 months.

Although the OS benefit was not statistically significant, the results form the phase 3 NETTER-1 study nevertheless showed that treatment with with 177Lu-Dotatate could offer benefits over high-dose octreotide, according to a commentary in Lancet Oncology.

The study, conducted in 231 patients with locally advanced or metastatic, well differentiated, somatostatin receptor-positive midgut neuroendocrine tumours showed that after follow up of more than six years the median overall survival was 48·0 months in the 177Lu-Dotatate peptide receptor radionuclide therapy (PRRT)  group and 36·3 months in the control group.

However the commentary noted that some patients with NETs might already have 18F-FDG-positive lesions that are unlikely to respond to somatostatin receptor-targeted PRRT alone. “The long-term results of NETTER-1 clearly also show that we have to spare patients from PRRT (alone) if their tumour lesions show features for progression as could be evidenced by 18F-FDG-PET/CT imaging. There is an urgent need to rethink the PRRT treatment strategy in these patients and to spare patients from PRRT if they are unlikely to benefit from it,” they said.

Prostate cancer concerns after fall in PSA testing

Urologists have expressed concern about a drop in PSA testing during the pandemic, which they say may result in fewer prostate cancers being detected at an early, treatable stage.

In a review of Medicare claims data for PSA testing by GPs they found there was a 5% reduction in PSA tests in 2020 compared to the previous year. There was no reduction in other tests such as free-to-total PSA, mpMRI and prostate biopsy, they noted, The reduction in PSA testing added to an ongoing downward trajectory in PSA testing overall in Australia since the USPSTF guideline recommendations against routine testing were made in 2012.

Writing in the British Journal of Urology they also noted a decline in GP attendances during the pandemic and fewer radical prostatectomies being performed in 2020- 2021 year compared to the prior year,

They concluded that “concern remains given the reduction in radical prostatectomies performed in 2021 because of missed PSA testing opportunity.”

Study aims to cut paediatric cancer infections

Reducing the rate of infections and complications in children with cancer caused by central venous access devices (CVAD) will be the focus of a University of Queensland paediatric cancer research study.

Clinical lead for the trial Dr Andy Moore, paediatric oncologist at Children’s Health Queensland and Associate Professor at UQ’s Child Health Research Centre said the research was needed because in Australia children undergoing treatment for cancer experience more than 250 bloodstream infections a year, 70 deep vein thromboses and 300 blockages – all caused from their central line.

When the CVAD is not in use, it is locked with fluid. This fluid lock is an opportunity to prevent these CVAD-associated complications, said Dr Moore.

“CVADs, which include central lines, PICCs and port-a-caths, are essential for cancer therapy. We’re hoping [an] innovative lock solution will help reduce the rate of line related infections, blockages and extra time in hospital which ultimately improves the child’s journey through their cancer treatment,” he added.

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