{"id":9879,"date":"2017-03-13T10:32:44","date_gmt":"2017-03-13T16:32:44","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=9879"},"modified":"2025-01-17T12:57:46","modified_gmt":"2025-01-17T19:57:46","slug":"sharper-imaging-sheds-light-on-hidden-tumors","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/sharper-imaging-sheds-light-on-hidden-tumors\/","title":{"rendered":"Sharper imaging sheds light on hidden tumors"},"content":{"rendered":"
<\/div>
\"Jeanne
Jeanne and John Lambert with dogs Mollie and Ollie outside Colorado Youth Outdoors’ Swift Ponds recreation center in Fort Collins.<\/figcaption><\/figure>\n

Jeanne Lambert was given at most five years to live in 2004. In 2017, a new imaging approach at UCHealth promises to help keep her neuroendocrine cancer in check into the future.<\/p>\n

That approach involves mainstay hardware \u2013 a positron emission tomography\/computed tomography (PET\/CT) scanner \u2013 and a radiopharmaceutical called Gallium-68 dotatate. Ga 68 dotatate lets nuclear medicine physicians see more, smaller neuroendocrine tumors than has been possible with previous imaging agents. Ga 68 dotatate, trade name Netspot, won U.S. Food and Drug Administration approval in June 2016; UCHealth University of Colorado Hospital (UCH) scanned the first of about a dozen patients so far starting in January.<\/p>\n

Lambert, now 73, was a perianesthesia care unit nurse at what\u2019s now UCHealth General Surgery in Fort Collins when a combination of symptoms including fatigue, breathing problems, hot flashes, confusion, randomly fluctuating blood pressure and, finally, an acute rectal bleed sent her to UCHealth Poudre Valley Hospital.\u00a0 Such a hodgepodge of symptoms, which combine into something called carcinoid syndrome, is common with neuroendocrine cancers. The tumors, called carcinoids, pour serotonin and other hormones into the body, disrupting the delicate biochemical equilibrium our bodies work so hard to sustain for our blithe enjoyment.<\/p>\n

She had surgery to remove a two-centimeter tumor from the small intestine; some of the intestine and neighboring colon went with it. A second surgery excised three large tumors from her liver and zapped four smaller ones with a radiofrequency ablation.\u00a0 She started taking monthly injections of Sandostatin LAR hormone analog to help alleviate her carcinoid syndrome as well to tackle hundreds of tiny tumors found on the surface of her liver. It worked. By the next year, Lambert and her husband John were spearheading the Fort Collins Run For Hope to raise awareness of carcinoids and funds for cancer research. Through a lecture series associated with the event, she met Tom Purcell, MD, MBA, executive director of Cancer Services for University of Colorado Hospital and the CU School of Medicine medical oncologist.<\/p>\n

Relapse<\/strong><\/p>\n

In September 2016, Lambert started wheezing and coughing. She didn\u2019t run a fever, she said, but \u201cit felt like I should be a TB patient in a sanatorium.\u201d<\/p>\n

\"Tom
Tom Purcell, MD, MBA, during a neuroendocrine multidisciplinary clinic.<\/figcaption><\/figure>\n

For three months she took the steroids and antibiotics her doctor prescribed, and then remembered back to 2004: \u201cAll those years ago, I had been diagnosed mistakenly with adult-onset asthma,\u201d Lambert said.<\/p>\n

She reached out to Purcell, who quickly scheduled her in the University of Colorado Cancer Center\u2019s neuroendocrine multidisciplinary clinic.<\/p>\n

\u201cThere is no other multidisciplinary program in the region that brings specialists and experts in neuroendocrine tumors to the table,\u201d said Purcell.<\/p>\n

An MRI showed no carcinoids. The next step was a PET\/CT scan, and the timing was good:\u00a0 use of Ga-68 dotatate radioactivity\u00a0 had required additional state approvals by the Colorado Department of Public Health and Environment. But by January, it was ready to go.<\/p>\n

Jennifer Kwak, MD, a University of Colorado Cancer Center nuclear medicine specialist, did Lambert\u2019s PET\/CT scan early that month. She explained how Ga-68 dotatate works.<\/p>\n

Cancer experts have known that carcinoid tumor cells have a lot of receptors for somatostatin, a hormone that regulates the endocrine system. The mainstay approach has been to do an indium-111 octreotide scan. In-111 octreotide binds to somatostatin receptors and emits radiation detected by PET\/CT. Ga 68 dotatate does the same thing, but the new compound binds with much greater affinity to somatostatin receptors, which greatly increases the detection sensitivity for neuroendocrine tumors that overexpress somatostatin receptors, Kwak said.<\/p>\n

A big fringe benefit for patients is that In-111 octreotide must be injected a day before imaging; Ga 68 dotatate is injected just an hour beforehand.<\/p>\n

\"This
Jennifer Kwak, MD, has been using Ga 68 for UCHealth neuroendocrine cancer patients since it became available in January.<\/figcaption><\/figure>\n

\u201cSo it\u2019s more like a two-hour process rather than two days,\u201d Kwak said.<\/p>\n

Lambert\u2019s Ga 68 dotatate PET\/CT scan showed two \u201ctiny\u201d possible carcinoids in the liver, Lambert said. They\u2019re small enough that Purcell suggested they watch and wait. \u201cI\u2019m not a good sitting-around-and-waiting type, but it\u2019s a little hard to do a biopsy intraoperatively if it\u2019s just a tiny amount showing up,\u201d she said. So they\u2019ll do another Ga 68 scan six months after the first.<\/p>\n

Tackling tumors<\/strong><\/p>\n

Soon, Kwak said, Lambert and other patients will have access to a Ga 68 dotatate treatment counterpart that binds to the tumor and kills the tumor with radiation. The idea is to inject an agent similar to Ga 68 dotatate \u2013 one that binds to somatostatin receptors \u2013 but which also emits cell-pounding beta radiation. Such a compound exists and is already approved in Europe: Lutetium-177 dotatate. Patients undergo a Ga 68 dotatate scan first to confirm the presence of carcinoids with somatostatin binding sites, then receive Lu-177 dotatate to attack the tumors. Also known as peptide receptor radionuclide therapy (PRRT), it\u2019s a great example of both the concept of \u201ctheranostics\u201d (therapeutics + diagnostics) and, more generally, of the precision medicine that\u2019s become a driving force in cancer care.<\/p>\n

Kwak said she expects the FDA to approve Lu-177 dotatate sometime this year, and in the meantime, Purcell is working to bring it to UCHealth sooner through the agency\u2019s compassionate use program.<\/p>\n

Lambert may or may not need it. Either way, this new Ga 68 dotatate scan has given the grandmother of eight peace of mind and a path forward.<\/p>\n

\u201cIt\u2019s finally here, and it\u2019s our hope,\u201d she said, adding that, until Ga 68 and its ability to image tumors previously unseen, hope was all she and others with neuroendocrine tumors had. \u201cI\u2019m so thrilled it\u2019s there for all of us.\u201d<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Jeanne Lambert was given at most five years to live in 2004. In 2017, a new imaging approach at UCHealth promises to help keep her neuroendocrine cancer in check into the future. That approach involves mainstay hardware \u2013 a positron emission tomography\/computed tomography (PET\/CT) scanner \u2013 and a radiopharmaceutical called Gallium-68 dotatate. Ga 68 dotatate […]<\/p>\n","protected":false},"author":23,"featured_media":9888,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28],"class_list":["post-9879","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology"],"acf":[],"yoast_head":"\nSharper imaging sheds light on hidden tumors - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Jeanne Lambert was given at most five years to live in 2004. 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