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Caring for Patients Receiving 177Lu-DOTATATE, Lutathera®: A Treatment of Hope for Patients With Gastroenteropancreatic Neuroendocrine Tumors

https://doi.org/10.1016/j.jradnu.2018.11.003Get rights and content

Highlights

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    A team approach is essential for the safe administration of Lutathera®.

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    Patients express renewed hope with FDA approval of Lutathera®.

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    Radiation safety is a key element to patient care in Lutathera® treatment.

Abstract

Lutathera®, the trademark for lutetium 177Lu-DOTATATE registered to Advanced Accelerator Applications SA, is a peptide receptor radionuclide therapy used to treat gastroenteropancreatic neuroendocrine tumors positive for hormone receptor somatostatin. Lutathera specifically targets known tumor receptors and has been shown to decrease both tumor growth and spread. While available in Europe for many years, the Federal Drug Administration approved the use of 177Lu-DOTATATE in the United States in January 2018. 177Lu (lutetium) is a radioactive isotope with special precautions and considerations for safe administration of this treatment. When nuclear medicine, radiation safety, nursing, and the physicians work together as a team, the safe administration of Lutathera provides patients with another treatment option to battle cancer.

Section snippets

Lutathera® and GEP-NETs

Lutathera®, the trademark for 177Lu-DOTATATE registered to Advanced Accelerator Applications, SA, Millburn, NJ, is a peptide receptor radionuclide therapy (PRRT) medicine used to treat gastroenteropancreatic neuroendocrine tumors (GEP-NETs) positive for hormone receptor somatostatin (Lui, 2015, LUTATHERA, 2018, Strosberg et al., 2017) (Box 1). Lutathera PRRT is an internal radioactive therapy in which 177Lu (lutetium), a radioactive isotope with a half-life of 6-7 days, is bonded to the amino

Potential adverse effects of Lutathera

Lutathera contributes to the overall radiation exposure that patients experience in their life time, and this cumulative radiation exposure is known to increase the risks for certain cancers. The most frequently identified adverse effects found in the phase 3 trial of Lutathera were gastrointestinal symptoms such as nausea, vomiting, and diarrhea, as well as abdominal pain and distension (Strosberg et al., 2017). Most patients reported these as symptoms in conjunction with the amino acids, with

Prescreening

During the prescreening process by the nuclear medicine physicians who will administer the Lutathera, patient preparation for treatment has already begun. Prescreening criteria include a known GEP-NET, positive diagnostic IN-111 Octeoscan or 68 GA-Dotatate scans, and that the patient is ≥18 years of age. Diagnostic scans confirm the GEP-NET receptor positive, thus indicating an expected uptake of 177Lu-DOTATATE by the tumor. In addition, pretreatment blood work needs to be evaluated

Conclusion—treatment of hope

Teamwork and collaboration among departments of nuclear medicine staff, radiation-safety personnel, radiology nursing, and the physicians are needed to successfully treat patients with GEP-NETs using the now FDA-approved Lutathera treatment process. Advanced Accelerator Applications (2018) provides detailed prescribing information to facilitate the creation of institution-specific policies and procedures for the administration of Lutathera while protecting patients and caregivers. Detailed and

References (10)

  • Introducing LUTATHERA® (Lutetium Lu 177 Dotatete)

    (2018)
  • M. Chen et al.

    US Food and Drug Administration, Center for Drug Evaluation and Research, Division of Risk Management. Evaluation of Need for a Risk Evaluation Mitigation Strategy (REMS). Reference ID: 4193058

    (2017)
  • F. Costa et al.

    Octreotide – a review of its use in treating neuroendocrine tumours

    European Oncology & Haematology

    (2013)
  • M. Diez et al.

    Gastroenteropancreatic neuroendocrinetumors: diagnosis and treatment

    Annals of Gastroenterology

    (2013)
  • E. Lui

    PRRT – What is it and how does it work? Healing net Foundation

There are more references available in the full text version of this article.

Cited by (0)

This work is unfunded and has not been previously presented.

Both authors declare no conflicts of interest.

No grant funding received.

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© 2018 Association for Radiologic & Imaging Nursing. Published by Elsevier Inc. All rights reserved.