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Research ArticlePractical Protocol Tips

177Lu-DOTATATE Peptide Receptor Radionuclide Therapy

Amanda Abbott and Heather Jacene
Journal of Nuclear Medicine Technology September 2018, 46 (3) 245-246; DOI: https://doi.org/10.2967/jnmt.118.217844
Amanda Abbott
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Heather Jacene
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The peptide receptor radionuclide therapy (PRRT) 177Lu-DOTATATE binds to somatostatin receptors (1). A multidisciplinary team should be involved when treating patients with 177Lu-DOTATATE PRRT, including medical oncologists, nuclear medicine physicians and technologists, nurses, radiation safety professionals, and pharmacists (2).

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TABLE 1

Radiopharmaceutical Identity, Dose, Route of Administration, Infusion Time, and Infusion Duration

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TABLE 2

Pharmaceutical Identity, Dose, Route of Administration, and Administration Requirements

Clinical Indications

Somatostatin receptor–positive gastroenteropancreatic neuroendocrine tumors in adults (1).

Contraindications

None (1).

Treatment Plan (1)

  • 7.4 GBq (200 mCi) of 177Lu-DOTATATE PRRT intravenously every 8 weeks (wk) for a total of 4 administrations.

  • Concomitant amino acid infusion to reduce the radiation dose to the kidneys.

  • Antiemetic medication(s) to reduce nausea and vomiting caused by amino acids.

Patient Preparation/Education

Patient education should include a detailed description of the treatment day and posttreatment care, including possible side effects, instructions about radiation safety to reduce exposure to others, fertility and precautions during sex, and the safe handling of body waste at home.

Before 177Lu-DOTATATE PRRT, the patient should:

  • Discontinue long-acting somatostatin analogs (long-acting-release octreotide [Sandostatin LAR Depot; Novartis] or Lanreotide Autogel [Somatuline Depot; Ipsen]) for at least 4 wk or short-acting somatostatin analogs (subcutaneous octreotide) for at least 24 hours (h) (1).

  • Consider changing into scrubs for the day (2).

During 177Lu-DOTATATE PRRT, the patient should tell the care team if any dizziness, flushing, loose stools, trouble breathing, or tightness of the throat occurs.

After 177Lu-DOTATATE PRRT, the patient should:

  • Empty his or her bladder as frequently as possible until the end of the third day after the treatment.

  • Tell the care team if loose stools last more than 24 h after the treatment.

  • Tell the care team if any trouble breathing, fatigue, fever, chills, cough, bleeding, or bruising occurs (2) (and seek immediate medical attention if, within 24 h of the treatment, dizziness, flushing, loose stools, trouble breathing, or tightness of throat occurs).

  • Keep all lab appointments.

Treatment Instructions

  • Check laboratory values, including creatinine, glomerular filtration rate, and complete blood count, before each treatment. Whether to proceed is a clinical decision (2).

  • Give antiemetic medication 30 minutes (min) before starting the amino acid infusion and then as needed.

  • Infuse at least 1/8 of the total volume of amino acids at least 30 min before the 177Lu-DOTATATE PRRT infusion, and continue the amino acid infusion for at least 4 h and up to 6–7 h, depending on the rate. A slower rate may help reduce nausea and vomiting (2).

  • Infuse the 177Lu-DOTATATE PRRT for approximately 30 min. If a neuroendocrine hormonal crisis occurs (dizziness, flushing, loose stools, trouble breathing, or tightness of throat), report it immediately.

  • Continue infusing amino acids until the entire volume has been given.

  • If needed, administer a long-acting somatostatin analog 4–24 h after the end of the 177Lu-DOTATATE PRRT (1).

Therapeutic Dose Calculations

  • Give the standard adult dose of 7.4 GBq (200 mCi) every 8 wk for 4 total administrations (1).

  • If adverse events occur, reduce the dose by half and delay up to 16 wk as described in the prescribing information (1).

Warnings/Precautions

177Lu-DOTATATE PRRT is a radioactive therapy, and appropriate radiation safety practices should be used (1).

REFERENCES

  1. 1.↵
    LUTATHERA® (lutetium Lu 177 dotatate) injection, for intravenous use [package insert]. Colleretto Giacosa (TO), Italy: Advanced Accelerator Applications S.r.l.; 2018.
  2. 2.↵
    1. Abbott A,
    2. Sakellis C,
    3. Andersen E,
    4. et al
    . Guidance on 177Lu-DOTATATE peptide receptor radionuclide therapy from the experience of a single nuclear medicine division. J Nucl Med Technol. 2018;59:237–244.
    OpenUrl
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Journal of Nuclear Medicine Technology: 46 (3)
Journal of Nuclear Medicine Technology
Vol. 46, Issue 3
September 1, 2018
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177Lu-DOTATATE Peptide Receptor Radionuclide Therapy
Amanda Abbott, Heather Jacene
Journal of Nuclear Medicine Technology Sep 2018, 46 (3) 245-246; DOI: 10.2967/jnmt.118.217844

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177Lu-DOTATATE Peptide Receptor Radionuclide Therapy
Amanda Abbott, Heather Jacene
Journal of Nuclear Medicine Technology Sep 2018, 46 (3) 245-246; DOI: 10.2967/jnmt.118.217844
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