PMC9063459_01
Nuclear Imaging. (A)
18F-FDG-PET/CT Oct 2018; (B)
18F-FDG-PET/CT Dec 2020; (C) Octreoscan Dec 2020.
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Figure 1  ). From December 2018 to October 2019, everolimus was reintroduced at a reduced dose of 5 mg, due to the previous hematological toxicity, allowing radiological stable disease without control of hypoglycemia events. At the same time, a 18F-FDG-PET/CT revealed a complete metabolic response compared to 2018 and Octreoscan showed intense hyperfixation of all secondary hepatic lesions in favor of SSTR2 expression ( Figure 1  ).
Immunostaining for SSTR2 (A) and SSTR5 (B). Immunostaining of metastatic hepatic lesion shows high expression of SSTR2 and low expression of SSTR5.
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Hypoglycemia events per month since beginning of Pasireotide.
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Subcutaneous short-acting pasireotide at a dose of 0.9 mg every 12 hours was initiated, resulting in rapid clinical status improvement and a prompt decrease of the frequency and severity of hypoglycemic events counted by a continuous glucose monitoring ( Figure 3 ).
Radiological (MRI Diffusion) to CAPTEM and pasireotide. (A) June 2020, before CAPTEM; (B) December 2020, after 6 cycles of CAPTEM; (C) February 2022, pasireotide alone.
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Tumoral response was assessed by hepatic MRI showing a partial response on December 2020 sustained through February 2022 ( Figure 4 ).
Timeline representing the anti-proliferative and anti-secretory treatments since diagnosis.
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The anti-proliferative and anti-secretory treatments since diagnosis are detailed in  Figure 5 .