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VICC debuts novel neuroendocrine tumor treatment

Apr. 24, 2014, 8:24 AM

Eric Liu, M.D., left, and Ronald Walker, M.D., talk with patient Harold Caplan, right, during an appointment to treat his neuroendocrine tumor. (photo by Daniel Dubois)

A retired elementary school principal has become the first patient at Vanderbilt-Ingram Cancer Center to receive an investigational cancer therapy for the treatment of his neuroendocrine tumor.

Harold (Cap) Caplan of Hilton Head, S.C., received the first injection of a drug that delivers a high dose of radiation directly to the cancer cells in his tumor.

The therapy using the radionuclide Lutetium-177 (177Lu) is being tested in a Phase 3 clinical trial. Vanderbilt is the only medical center in a multi-state southern region participating in the trial, which is also being conducted at several centers in the United States and Europe.

Eric Liu, M.D., assistant professor of Surgery and Radiology and Radiological Sciences, is the principal investigator at Vanderbilt for the trial, dubbed NETTER-1.

“This is a very well-known therapy in Europe and until now we have been referring our patients there. One of the places that delivers it is the center where I trained in Uppsala, Sweden,” said Liu.

Caplan has already survived kidney cancer and prostate cancer. During annual checkups for the kidney cancer, doctors found a lesion on his liver. But this wasn’t a recurrence of the kidney cancer.

Surgeons found the primary tumor in his small intestine and determined it was a neuroendocrine tumor, a rare form of cancer that usually arises from cells in the lung or the digestive tract.

Caplan started looking for experts and found Liu, who specializes in these types of tumors.

“These are a difficult type of cancer to take care of because they have unusual traits,” Liu said. “Not only do these tumors grow but they also secrete hormones, which can create lots of symptoms. They can be quite difficult to diagnose and require a multimodal approach to care.”

For the current trial, Liu is collaborating with Ronald Walker, M.D., professor of Clinical Radiology and Radiological Sciences, who spearheaded previous research on the technology being used.

Walker and colleagues helped develop and test the Gallium-68 DOTATATE compound for PET/CT scan, which provides higher resolution images for diagnosing neuroendocrine tumors. Vanderbilt was the first institution in the United States to use the Gallium-68 PET/CT scan to detect neuroendocrine tumors.

“Neuroendocrine tumors have a molecule called somatostatin receptor on the surface of their cells,” said Walker. “DOTATATE sticks to it and is taken into the cell. The DOTATATE has the gallium on it so it lights up the cancer cells like a light bulb on our scans.”

For the new clinical trial, physicians are using the same DOTATATE to target the tumors by changing the gallium for the radioactive Lutetium-177 to deliver a lethal dose of radiation directly to the tumor.

Walker describes this treatment combination as … “a molecule-sized smart bomb that seeks out these cells.”

Caplan was comfortable about testing the new therapy since it has already been used in Europe.

“I jumped at the chance to hopefully get into this trial and I am the first one at Vanderbilt. Hopefully this will be a big benefit to me,” said Caplan.

Caplan will return every eight weeks for a series of four treatments, with additional lab tests at regular intervals.

Meanwhile, the 77-year-old works hard to maintain his physical stamina by swimming, running and lifting weights.

His wife, Sandy, hopes the therapy will give him more time for what she calls his best activity — dancing.

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