Abstract
Excellent partial response with a single cycle of peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE in Merkel cell carcinoma with multiple bilobar hepatic metastases is illustrated in this report. Documentation of such response coupled with minimal side effects would warrant consideration of this therapy early in the disease course, if the metastatic lesions demonstrate adequate tracer avidity on Somatostatin receptor (SSTR) based imaging (rather than in an advanced state following failure of other therapies). Our patient demonstrated systemic disease progression following the second surgery and adjuvant radiotherapy to head and neck and chemotherapy and hence was considered for PRRT. The metastatic lesions demonstrated both SSTR and FDG avidity in the pre-treatment diagnostic study. Scan evidence of partial response in both scan parameters at 3 months before being worked up for the 2nd cycle of PRRT including two lesions demonstrated near-complete resolution. In view of the relative well tolerability, minimal side-effects and targeted nature of the treatment, PRRT can evolve as the first line therapy in patients of metastatic Merkel Cell carcinoma and needs further examination in more patients in the future.
