Lutetium-177 DOTA-TATE
What is Lutetium-177 DOTA-TATE Therapy ?
Neuroendocrine tumors (NET); They are rare cancers that can occur anywhere in the body, especially in the intestine, pancreas and lungs.
Theranostic is a new and emerging field in the medical world. It is based on the realization of imaging and treatment on a single system, allowing the specific treatment and follow-up of treatment simultaneously.
Diagnosis and treatment of neuroendocrine tumors can be done by using some imaging agents in theranostic applications. Of these agents, Ga-68 DOTA-TATE PET / CT can visualize tumoral tissues with high sensitivity, and Lu-177 DOTA-TATE can perform specific and targeted treatment of tumoral tissues. This is a very successful and new method for theranostic applications.
Lu-177 DOTA-TATE is a treatment method used in neuroendocrine tumors. It is also referred to by different names such as “targeted radionuclide therapy”, “peptide receptor radionuclide therapy (PRRT)” “somatostatin receptor radioligand therapy”.
How Does Lutetium-177 DOTA-TATE Treat?
Lu-177 DOTA-TATE treatment uses a drug consisting of DOTA-TATE, a man-made (synthetic) form of the natural somatostatin hormone, and the radioactive element Lutetium-177.
This combined drug is administered to patients intravenously. The drug binds with DOTA-TATE to the surface of neuroendocrine tumors, and with Lutetium-177 a high dose of local radiotherapy is irradiated directly to the tumor.
The goal of Lu-177 DOTA-TATE therapy is to slow or stop tumor growth and reduce some of the symptoms caused by the tumor. Lu-177 DOTA-TATE treatment usually consists of four cycles administered 8 to 12 weeks apart.
In this section, we aim to answer your questions about Lu-177 DOTA-TATE treatment and explain the benefits, risks and alternatives of treatment. If you have a different question or concern, please contact your referring physician.
Who is Lutetium-177 DODA-TATE Treatment Applied?
Your physician may recommend this treatment when you have a neuroendocrine tumor that gets worse and stops responding to other treatments. Studies show that lutetium therapy can improve life expectancy and quality and alleviate symptoms and complaints in people with neuroendocrine tumors.
Before starting treatment, a special kidney test called glomerular filtration rate (GFR) will be done to check how well your kidneys are working.
What Are The Alternative Treatments?
There are different treatment options that can help patients with neuroendocrine tumors:
Pain relievers: It reduces pain.
Somatostatin analogsı: These are synthetic forms of somatostatin hormone and octreotide etc. includes medications. It is given by injection to relieve tumor-related complaints (symptoms) and to help stop your disease.
Interferon alpha: It is a biological treatment that can help prevent tumor growth and the symptoms it causes. It is given by injection.
Surgery : If the tumor is accessible, surgery can remove the tumor completely or reduce the size of the tumor to improve symptoms.
Chemotherapy : These drugs are used to improve symptoms by reducing tumor size. It is usually given through a vein in the back of the hand or arm. However, most neuroendocrine tumors are not very sensitive to chemotherapy treatment.
Targeted therapies (eg. sunitinib or everolimus); These drugs are taken by mouth to slow tumor growth and metastasis.
Embolisation: It is a technique used to control symptoms by reducing blood flow to the tumor. It can sometimes be used in combination with chemotherapy or radiation therapy to prevent the growth of tumor cells.
Radiofrequency ablation: It is a procedure performed under general anesthesia that uses low electrical current to conduct heat to suppress liver tumors.
Other targeted radionuclide therapies: Radionuclide treatments such as 131I-mIBG.
These treatments can be used one after the other or in combination with the recommendation of your physician. After discussing all treatment options, you can choose to receive or not receive any treatment. In addition, your physician may think that such treatments cannot help you and may recommend palliative care. This helps support you and relieve your symptoms.
Is Lutetium-177 DOTA-TATE Treatment Safe?
Our NET patients receiving Lu-177 DOTA-TATE treatment experience minimal and less severe long-term side effects compared to other cancer treatments.
The radiation used in this treatment is designed to directly damage and destroy cancer cells. Since most of Lu-177 DOTA-TATE goes to tumor tissue, damage to healthy tissues is minimal.
However, as radiation can affect the kidney and bone marrow, patients are followed up with post-treatment blood tests.
In treatment; In general, two types of side effects may occur, either related to treatment itself or related to the radiation dose to which the body is exposed:
1. Treatment-Related Possible Side Effects
- You may feel nauseous, usually only on the day of treatment. To prevent this, anti-nausea medications are given beforehand.
- Inflammation in the tumor can lead to an increase in pain, which we can see in patients with tumors in the bone, liver or pancreas. This condition usually resolves within 72 hours of treatment. You will need to use low-dose steroids (dexamethasone) to help reduce the symptoms, however we also recommend taking your regular pain medication more regularly.
- It may cause a temporary increase in the intensity of your daily symptoms such as flushing, sweating, palpitations or wheezing, and an increased frequency of existing diarrhea. This situation usually stabilizes within 24-48 hours, and you may need to increase the amount of antidiarrheal medication you use.
- A few weeks after each course of treatment can make you feel weakly.
- Temporary hair thinning is a condition that can be seen in some of our patients, and it returns to normal again after the Lu-177 DOTA-TATE treatment is completed.
Of course, it is also possible that you may not feel different than normal and not experience any of these side effects.
2. Radiation Dosage Related Side Effects
Although healthy normal cells show a very low amount of Lu-177 DOTA-TATE uptake compared to tumor tissue, the side effects of radiation can also damage these cells.
Lu-177 DOTA-TATE treatment can also affect parts of your body other than tumors. It can particularly affect your bone marrow and kidneys. This may cause you to feel weakly than usual or be more susceptible to infection for a few weeks after treatment.
You will need regular blood tests after each course of treatment to check your blood count (blood cells) and to see how your kidneys and liver are working. Secondary myelodysplastic syndrome and leukemia have been reported, although very rarely.
It is important to tell your physician if you have any new or unexpected health problems after Lu-177 DOTA-TATE treatment, even if they are not listed above.
Lutetium-177 DOTA-TATE and Pregnancy
Before starting each course of Lu-177 DOTA-TATE, all women of childbearing age are asked to provide a urine sample for pregnancy testing to exclude the possibility of pregnancy. Both men and women are advised not to become pregnant during their treatment and for at least six months after completing treatment. During this time, reliable contraceptive methods should be used. You can consult your physician for more detailed information.
What are you asked to do before lutetium-177 DODA-TATE treatment?
For each course of treatment, you will have several days of hospital visits. You may need to be hospitalized for treatment. Four courses of treatments take eight to ten months to complete. Your control appointment will be scheduled after your last course of treatment is completed. During this period, you should also be in contact with your referring physician who follows you.
Before each course of treatment, you will be asked to have a blood test and a physical examination. These procedures will help us evaluate your suitability for treatment, along with a brief querry about your general health.
You must inform us about all the medicines you use (including those that are not prescribed by your physician). If you are being treated with octreotide (Sandostatin LAR®) or lanreotide injections, we also need to know the date of your last injection. This is important so that we can plan your Lu-177 DOTA-TATE treatment cycle to deliver in the days just before your injection. If you are injecting octreotide daily, we will let you know when to stop. Unless otherwise stated during your pre-treatment appointment, you can eat and drink on the day of your treatment and take all your other medications normally.
If you need to stay in the hospital overnight after treatment, you will need personal supplies.
The time visitors can spend with you will be limited by radiation. You will be informed about this before starting the treatment. However, children under the age of 16 and pregnant women should not come with you or visit you.
How is Lutetium-177 DOTA-TATE Treatment Applied?
Your treatment will be performed by the Nuclear Medicine Department and the entire procedure will take about five hours to complete.
A plastic cannula (a small plastic tube) will be inserted into a vein in your arm. Through this cannula, you will first be given medication to prevent you from nausea feeling, then an amino acid infusion (in drop form) to help protect your kidneys from radioactivity.
Approximately one hour later, the amino acid infusion will be discontinued for Lu-177 DOTA-TATE administration. After the Lu-177 DOTA infusion is completed in approximately 30 minutes, the amino acid infusion will resume and the process will continue for another three hours. After the procedure is completed, the cannula will be removed.
What To Do After Lutetium-177 DOTA-TATE?
The next morning, we will be waiting for you at the Nuclear Medicine Department for post-treatment scans. These scans will be done to check that your treatment is going as planned, and scanning may take an hour or two.
After the scans, a healthcare professional from our Nuclear Medicine team will measure your radiation levels and inform you about the precautions to follow when leaving the hospital. These measures are necessary to reduce the radiation dose that people around you may be exposed to. If the radiation level in your body is low enough after the measurement, you can go home.
After Leaving Hospital
Be sure to follow the advice given to you on radiation precautions.
After each course of treatment, you will be asked to have a blood test every 2 weeks for 8 to 10 weeks to check the effect of the treatment on your blood cells, kidneys and liver.
Return to Work
The type of work you do will be taken into account in deciding when to return to work. Your Nuclear Medicine Physician will discuss this with you.