Amino Acid Solutions for 177Lu-Oxodotreotide Premedication: A Tolerance Study

Abstract

Background: The co-infusion of amino acid solutions during peptide receptor radionuclide therapy reduces the tubular reabsorption of 177Lu-oxodotreotide, thus minimizing nephrotoxicity. In our nuclear medicine department, the patients received two different types of amino acid perfusion over time: a commercial solution (CS) containing 10% amino acids, and a 2.5% lysine–arginine (LysArg) hospital preparation, produced by a referral laboratory. The aim of the present study was to analyze the tolerance of the two amino acid solutions. Methods: The patient files were analyzed and double-checked. The study parameters comprised the gender, age, primary tumor site, type of amino acid perfusion, adverse events (AE) and WHO AE grades, antiemetic premedication, creatinine, and serum potassium level. Results: From February 2016 to February 2019, 76 patients were treated, for a total 235 cycles. AEs occurred in 71% of the CS cycles (n = 82/116), versus 18% (n = 21/119) in the LysArg group (p < 0.0001). In the CS group, the AEs were mostly WHO grade 4 (n = 24/82), and mostly grade 1 in the LysArg group (n = 13/21). Poisson regression showed a higher risk of AE overall and of grades 3 and 4 in the females and with CS. The mean creatinine clearance was identical before and after the PRRT cycles, whichever amino acid perfusion was used. Conclusion: The lysine–arginine preparation showed better tolerance than the commercial solution. The change to LysArg reduced the antiemetic premedication from four molecules to one.

Safety and Therapeutic Optimization of Lutetium-177 Based Radiopharmaceuticals

“…This infusion is started about 30 min before the Lutathera®infusion and continues for 4 h [45,57,60,61] (Figure 3). Other infusion protocols exist as well as other commercial solutions of amino acids, but are often more osmolar and therefore more at risk of adverse effects such as nausea and vomiting [45,61,62].…”

Renal Disturbances during and after Radioligand Therapy of Neuroendocrine Tumors—Extended Analysis of Potential Acute and Chronic Complications

“…Nevertheless, the study was conducted on a group with initially normal kidney functions (GFR 108 ± 5 mL/min) [ 9 ]. There are several ways to overcome the nephrotoxicity of RLT, of which the most important is nephroprotection with amino acid infusion and good hydration of the patient [ 10 ]. The possible use of renin-angiotensin-aldosterone system blockers (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers or aldosterone receptor blockers), α1-microglobulin, amifostine or even metformin requires further investigation [ 8 ].…”