Plenary Lecture

Advances in Treatment in Pheochromocytoma (or Paraganglioma)

Professor Salvador Borges-Neto
Radiology/Nuclear Medicine
Duke University
Durham, NC, USA

Abstract: OBJECTIVES: Available data on treatment of pheochromocytoma or paraganglioma with high dose iodine-131-meta-iodobenzylguanidine (MIBG) is limited by small cohorts and short follow up intervals. We report response and progression-free survival from a cohort of n=125 patients with stage IV pheochromocytoma or paraganglioma treated with palliative 131I-MIBG between 1991 and 2014, with mean follow up of 60 months, total of 593 person-years of follow-up. METHODS: Retrospective chart review of a registry of patients receiving median dose 18,833 MBq (509 mCi) 131I-MIBG at an academic tertiary referral center. Imaging response (n=88) was assessed via Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 where imaging was available, or by official imaging report where images were not available for review. Symptom response (n=83) was assessed by chart review of clinical encounters with the oncology service. Lab response (n=50) was defined as 20% change in 2 consecutive values from baseline in catecholamines / VMA, metanephrines or chromogranin A. Following initial MIBG therapy, 32% received additional rounds of MIBG. RESULTS: At first follow up, 75% of patients reported improvement in pre-treatment symptoms, which consisted primarily of pain (60%), fatigue (35%) and hypertension (27%). 39% experienced no symptomatic progression through follow-up; median time to symptomatic progression of was 1.8y ± SE 0.4. Initial follow up imaging demonstrated 1% complete response, 33% partial response, 53% stable disease and 13% progression. 49% of patients showed no post MIBG imaging progression with median time to progression of 2.0y ± 0.6. 59% of patients demonstrated lab response and 24% were stable on initial lab follow up. 50% of patients remained without lab progression after treatment throughout follow-up time, with median time to laboratory progression of 2.8y ± 0.7. Median survival from diagnosis was 11.5y ± 2.4. Median survival following the development of metastatic disease was 6.5y ± 0.8. Survival post treatment was 4.3y ± 0.7. Stable or partial response vs. progression at first imaging follow up predicted improved survival (5.6y ± 0.7 vs. 2.1y ± 1.2, p<0.05). CONCLUSION: Imaging, symptomatic and laboratory response to high dose 131I-MIBG were achieved on long-term follow up in a large cohort with advanced pheochromocytoma or paraganglioma. Initial response by imaging was associated with prolonged survival. Accordingly, stratification by response at first follow up imaging may be valuable to inform subsequent treatment decisions.

Brief Biography of the Speaker: Dr. Borges-Neto received his medical doctorate from the Federal Fluinense University in Brazil. He completed an internship in Medicine at Antonio Pedro University Hospital in Rio de Janeiro, Brazil followed by a three-month elective in the cardiovascular division at Brigham and Women’s Hospital Harvard Medical School in Boston, Massachusetts. From August 1982 to August 1984 he complete a cardiology fellowship at Antonio Pedro University Hospital in Brazil; from October 1984 to October 1985 he was a research fellow in the Medicine/Cardiovascular division at Brigham and Women’s Hospital in Boston; from January 1986 to December 1986 he was a Research Fellow in Cardiology/Nuclear Cardiology at the Methodist Hospital Baylor College of Medicine in Houston, Texas; and from September 1988 to December 1991 he was a Research Fellow in Nuclear Cardiology at Duke University Medical Center in Durham, North Carolina. Dr. Borges-Neto completed his Nuclear Medicine Residency in the Department of Radiology at Duke University Medical Center in 1993. After completing his residency he served as an Assistant Professor of Radiology at the Medical University of South Carolina. Dr. Borges began his career at Duke University Medical Center in 1994 as an Assistant Professor of Radiology. During his tenure at Duke University he has risen to the rank of Professor of Radiology and Internal Medicine. In 2001 Dr. Borges became the Director of the Nuclear Cardiology Laboratory; in 2007 he became the Co-Director of Cardiovascular Imaging in the Duke Heart Center; and in 2008 he became and remains the Medical Director of Nuclear Cardiology for the Duke Health System. In September 2013 he became Interim Division Chief for The Division of Nuclear Medicine and finally appointed as Division Chief in March 2014 until present time. Dr. Borges-Neto has lectured extensively internationally on the field of nuclear cardiology and has published 100+ publications in peer reviewed scientific professional journals. He is a Fellow of the American College of Nuclear Physicians , founding member and Fellow of the American Society of Nuclear Cardiology, Fellow of the American College of Cardiology, and Fellow of the American Heart Association Council on Cardiovascular Radiology. He serves on the editorial board of the Journal of Nuclear Medicine and is associate editor for The American Heart Journal., and Guest Editor for Circulation. He has served on the advisory board for the American Society of Nuclear Cardiology and is a past member and President of the Board of Directors of the Cardiovascular Council of SNMMI.
Dr. Borges-Neto’s clinical interests includes, the role of Nuclear Cardiac and Nuclear Oncology imaging in predicting outcomes and guiding therapy. His research interests include (1) combined myocardial perfusion and functional Nuclear imaging for the evaluation of patients with suspect or known ischemic heart disease, (2) ) new radionuclide tracers and agents for the treatment of patients with Neuroendocrine Tumors and General Oncology.Dr. Borges-Neto has recently been directly involved with new PET tracers for early diagnosis of Alzheimer’s disease.

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