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68Ga DOTATATE Positron Emission Tomography (PET) at Mayo Clinic
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This article regarding 68Ga DOTATATE Positron Emission Tomography (PET) comes to us from Mayo Clinic's, Dr. Ayse T. Kendi and Medical/NET oncologist Dr. Thorvardur Halfdanarson, regarding this new diagnostic tool for imaging NETs. As this is now available at Mayo Clinic, Rochester, MN, I wanted you all to be aware of it.
68Ga DOTATATE Positron Emission Tomography (PET) is the new golden standard for imaging of neuroendocrine tumors (NETs). [68Ga] DOTATATE PET has been used in Europe and Australia for the last 10 years effectively as the first line imaging choice for NETs and replaced Octreoscan years ago. Recently this imaging modality has been approved by FDA and was made available to the NET community in USA. 68Ga DOTATATE has unique ability to bind to the somatostatin receptors that are overpopulated on the cell surface of NET cells. The somatostatin receptors can serve both as a target for imaging such as Ga68 DOTATATE PET/CT imaging and the less accurate Octreoscan as well as a target for therapy, either with somatostatin analogs (octreotide and lanreotide) and radioactively tagged somatostatin analogs such as Lu-177 DOTATATE (Lutathera). Gallium is the part that acts like a light-source that is attached to the peptide (DOTATATE) which has high affinity to bind to these receptors. Once the [68Ga] DOTATATE is injected through a vein and circulates in the body for about 60 minutes, it is time to get the images. Unlike Octreoscan, you don’t need to have multiple visits to nuclear medicine. One visit for about 2 hours is all that is needed.
68Ga DOTATATE can detect more and smaller lesions than the older Octreoscans, has lower radiation and is essential for assessment for peptide receptor radionuclide therapy (PRRT). With the advent of Ga68 imaging, there is no role for Octrescans where Ga68 imaging is available. Please know that although most of NETs will light up, some won’t light up and you may need another imaging with MRI, CT or FDG-PET/CT.
Please also note that, although it is FDA approved, it is an imaging modality that is not available in every hospital or imaging center. Please make sure to ask your NET oncologist if and where you could get the imaging.
At Mayo, we have completed more than 100 cases since November 2016. As a team we are very efficient both in acquisition and interpretation of the images. We work in close collaboration of NET oncologists in our institution and most, if not all patients will be offered the opportunity to meet with a NET specialist within then Division of Medical Oncology to discuss the results of the Ga68 DOTATATE imaging study and to formulate a treatment plan going forward which also will include the use of circulating blood markers as indicated. There are now data to suggest that treatment outcomes are better for patients treated at large and specialized NET centers.
Please feel free to comment or ask any questions that you may have. I will see that your questions are answered by one of our clinicians at Mayo.
Teresa
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HugInterested in more discussions like this? Go to the Neuroendocrine Tumors (NETs) Support Group.
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Hello, sophiarose! I have pancreatic NET with liver metastases. My oncologist suggested Ga68 dotatate PET scan which guided him through my surgery. I live in Syracuse, NY and it is available here! Dr.Dhir who did my surgery has become the first doctor (And Upstate Cancer Center) to offer robotic Wipple procedure! Check Syracuse, it could be easier to come here than do JAX?
Hello Teresa,
If I had a minimal uptake 2.1 SUV 1cm tumor (multiple other had no uptake) on a 68-dotatate scan looking for lung nets, should I ask for one of the other types of scans mentioned in the article. I still need to see a specialist because my hospital has no idea ( I think) they just want to see if it grows and watch it. Also on my last CT which wasn’t mentioned on any other type of scans including the pet, they say I now have a bone lesion. I’m a little concerned about both. The doctors say I have Dipnech and DPM.
Thanks Sherry
Hello @happycat and welcome to the NETs support group on Mayo Connect. With any NETs diagnosis it is important to have at least one consultation with a NET specialist. Mayo Clinic has NET specialists at all three of their locations. If you would like to inquire about an appointment here is a link to appointment information at Mayo, http://mayocl.in/1mtmR63. If for any reason, you cannot obtain a Mayo appointment, here is a listing of NET specialists worldwide,
https://www.carcinoid.org/for-patients/treatment/find-a-doctor/
How are you feeling, @happycat? Any breathing problems or pain from the bone lesion?
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1 ReactionHello, Like many others I’ve had years of terrible cough which I have taken two inhalers, Asthma tablets, allergy meds, sinus meds and multiple rounds of prednisone which is better but, seems like after about a month the cough comes back. I have had a lot of back pain for a long time so I’m not sure if it’s just old age or something more. I have been in contact with Dr Pommier’s office I was just waiting for my medical records to get there before I go for an appt. Thanks
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1 ReactionHello @sophiarose,
I am so glad to hear that you were able to meet Dr. Starr. If you have previously seen Dr. Starr, his office staff might be able to answer that question for you.
Will you post again and let me know how you are doing and what decision you make regarding the PRRT treatment?
I meet some of his staff they are wonderful
The issue I have is that this looks like the Everolimus I took for 9 weeks has given me a heart issue
I am on medication which is helping but I am so exhausted and have days when it is really hard to function
I don’t know if I will have the strength to travel to Florida
I know in my heart that I will get excellent care and support at Mayo
If I do NY City I will get excellent care but not the support
It is very upsetting the unknown symptoms of the PRRT scare me
I see my cardiologist on Monday I am hoping we can put our heads together and make a decision
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1 ReactionHello @sophiarose,
I am sorry to hear of the heart issue that you are having as a result of the Everolimus. If you are comfortable sharing more, I'm wondering what type of heart issue you are dealing with. I can understand that this new health issue will make this decision more difficult, especially as you consider traveling. When you said that you would have more support in Florida, is that because you have friends or family there who could help you?
You are wise to consult with your cardiologist before making a final decision. The more medical input you can obtain, the more confident you will be about what direction to take.
Will you post again after you see your cardiologist?
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1 ReactionActually after meeting with Dr Starr and his team and Lorielli I feel I would have a lot more support
I developed PVC from the Everolimus
It started in about the 7th week of treatment but by the 9th week it was full blown I was having a terrible time catching my breath my pulse was skipping and my heart was pounding out of my chest
Even though the doctors felt my irregular pulse
I had a perfect ECHO , EKG and a MRI of my heart
It wasn’t until my cardiologist sent me to the hospital and hooked up to the 24 monitor that they saw what was going on
I am on a beta blocker and it is a lot better just hoping it isn’t permanent
I will keep you posted
Thank you for your concern
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1 Reaction@sophiarose, your mention of heart issues tipped me off to let you know about cardio-oncology.
Mayo Clinic offers expertise in addressing heart problems (called cardio-oncology), potential or current issues. The Cardio-Oncology Clinic (https://www.mayoclinic.org/departments-centers/cardio-oncology-clinic/overview/ovc-20442193) evaluates people prior to cancer treatment and patients who have experienced side effects due their treatment.
You might wish to inquire about a consult with a cardio-oncology specialist, although it sounds like you're already in good hands. Just thought I'd make you aware of the specialty.
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2 ReactionsThank you Colleen
I will keep the web site you sent
So far the medication the cardiologist gave me at the hospital is working
I was suppose to see my cardiologist on Monday but that was moved to 4/1
I am holding onto hope that the issue isn’t permanent
Thank you very much
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