Therapy With <sup>177</sup>Lu-DOTATATE: Clinical Implementation and Impact on Care of Patients With Neuroendocrine Tumors

Kendi, Ayse T.; Halfdanarson, Thorvardur R.; Packard, Ann T.; Dundar, Ayca; Subramaniam, Rathan M.

doi:10.2214/ajr.19.21123

Cited by 41 publications

(31 citation statements)

References 51 publications

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“…Nausea was reported in 71% of patients receiving commercially available amino acids, whereas it was observed in only 5% of patients receiving compounded amino acids (17). An oral and intravenous bolus of antiemetic solution given before amino acid solution decreases these adverse effects, as well (18).…”

Section: Early Adverse Effectsmentioning

confidence: 99%

“…Therefore, lower-volume amino acid solution may be considered for these patients. Concentrated amino acid solution administration for these patients may result in electrolyte abnormalities, such as hyperkalemia (18,19). Local infusion site reactions sometimes occur, characterized by linear, weblike erythema along the path of the extremity veins.…”

Section: Early Adverse Effectsmentioning

confidence: 99%

“…Radionuclides, such as fluorine 18 ( 18 F) and copper 64 ( 64 Cu), are more easily transported from centralized production sites because of longer half-lives and therefore offer logistical advantages compared to 68 Ga, which requires local generator production. Investigation of 18 F-labeled somatostatin analogs have shown promise in preclinical studies, but these analogs have not yet been implemented in the clinical setting (4,33). Compared with 68 Ga DOTATOC, 64 Cu DOTATATE has a longer shelf life and physical half-life, with increased lesion detection compared with 68 Ga DOTATOC; however, to our knowledge, practice, this is managed as a type of phlebitis.…”

Section: Imaging For Treatment Planning and Assessment Responsementioning

confidence: 99%

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How We Do It: A Multidisciplinary Approach to ¹⁷⁷Lu DOTATATE Peptide Receptor Radionuclide Therapy

et al. 2021

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Lutetium 177 (177 Lu) DOTA-0-Tyr3-Octreotate (DOTATATE) peptide receptor radionuclide therapy (PRRT) is an effective treatment for advanced gastroenteropancreatic neuroendocrine tumors. This review presents a clinical practice workflow that has been successful since 177 Lu DOTATATE PRRT was approved by the U.S. Food and Drug Administration. The workflow relies heavily on the input of a multidisciplinary team and involves a nuclear medicine consultation service, tumor board, and specific preparations in advance of therapy and day-of-therapy procedures. A systematic checklist designed to ensure appropriate selection of treatment candidates and identification of any concerns to address to safely administer PRRT is provided. All patients were evaluated with gallium 68 DOTATATE PET/CT, and in cases of high-grade tumors, they were also evaluated with fluorine 18 fluorodeoxyglucose PET/CT, with imaging findings reviewed as part of the systematic checklist before PRRT. Adverse effects are discussed and imaging follow-up regimens are reviewed, including alternative diagnostic contrast materials. Approaches to multiple challenging patient scenarios are illustrated through case examples. Finally, alternative theranostic radionuclides and treatment strategies are discussed.

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Section: Early Adverse Effectsmentioning

confidence: 99%

Section: Early Adverse Effectsmentioning

confidence: 99%

Section: Imaging For Treatment Planning and Assessment Responsementioning

confidence: 99%

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How We Do It: A Multidisciplinary Approach to ¹⁷⁷Lu DOTATATE Peptide Receptor Radionuclide Therapy

et al. 2021

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“…Because this is targeted systemic radiation therapy, federal safety regulations should be applied during and after 177 Lu-DOTATATE administration. Before administration of systemic radionuclide therapy, a nuclear medicine physician or a nuclear radiologist who has authorized user status with competency in the administration of parenteral radioactive therapies needs to counsel the patient regarding details of the therapy, potential adverse effects, and radiation safety instructions that the patient needs to apply during therapy and after leaving the treating medical facility (1,2).…”

mentioning

confidence: 99%

“…Radiation emission after 177 Lu-DOTATATE therapy is low, allowing the treatment to be done in the outpatient setting (1-3). Except for the first few days after therapy, there are no specific restrictions for contact with other persons (1,2). Radiation activity persists at low levels for several weeks after therapy because of ongoing decay of the administered radionuclides (4).…”

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confidence: 99%

Patient Travel Concerns After Treatment with ¹⁷⁷Lu-DOTATATE

Kendi

Mailman²,

Naraev³

et al. 2020

J Nucl Med

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Laboratory, Clinical, and Survival Outcomes Associated With Peptide Receptor Radionuclide Therapy in Patients With Gastroenteropancreatic Neuroendocrine Tumors

et al. 2021

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IMPORTANCE Peptide receptor radionuclide therapy (PRRT) is approved in the US for treatment of gastroenteropancreatic neuroendocrine tumors (NETs), but data on PRRT outcomes within US populations remain scarce. OBJECTIVE To analyze the first 2 years of PRRT implementation at a US-based NET referral center. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using medical records of patients with metastatic NET receiving PRRT from 2018 through 2020 in a NET program at a tertiary referral center. Included patients were those at the center with metastatic NETs who received at least 1 dose of PRRT over the study period. Laboratory toxic effects were assessed using Common Terminology Criteria for Adverse Events version 5.0. Tumor response was determined using Response Evaluation Criteria in Solid Tumors 1.1. Survival analysis was conducted to identify factors associated with progression-free survival (PFS) and overall survival. Data were analyzed from August 2018 through August 2020. EXPOSURES Receiving 4 cycles of lutetium-177-dotatate infusion, separated by 8-week intervals targeted to 7.4 GBq (200 mCi) per dose. MAIN OUTCOMES AND MEASURES Data were compared from before and after PRRT to determine hematologic, liver, and kidney toxic effects and to assess tumor progression and patient survival. RESULTS Among 78 patients receiving at least 1 dose of PRRT, median (interquartile range) age at PRRT initiation was 59.8 (53.5-69.2) years and 39 (50.0%) were men. The most common primary NET sites included small bowel, occurring in 34 patients (43.6%), and pancreas, occurring in 22 patients (28.2%). World Health Organization grade 1 or 2 tumors occurred in 62 patients (79.5%). Among all patients, 56 patients underwent pretreatment with tumor resection (71.8%), 49 patients received nonsomatostatin analogue systemic therapy (62.8%), and 49 patients received liverdirected therapy (62.8%). At least 1 grade 2 or greater toxic effect was found in 47 patients (60.3%). Median PFS was 21.6 months for the study group, was not reached by 22 months for patients with small bowel primary tumors, and was 13.3 months for patients with pancreatic primary tumors. Having a small bowel primary tumor was associated with a lower rate of progression compared with having a pancreatic primary tumor (hazard ratio, 0.19; 95% CI, 0.07-0.55; P = .01). Median overall survival was not reached. CONCLUSIONS AND RELEVANCE This cohort study of patients with metastatic NETs found that PRRT was associated with laboratory-measured toxic effects during treatment for most patients and (continued) Key Points Question What are the clinical outcomes for patients who receive peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumors (NETs) in US-based populations? Findings In this cohort study of 78 patients who underwent PRRT, the treatment was associated with transient laboratory-measured toxic effects in most patients. Median progression-free survival was significantly increased for patients with small bowel primary tumors compared with p...

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Therapy With ¹⁷⁷Lu-DOTATATE: Clinical Implementation and Impact on Care of Patients With Neuroendocrine Tumors

Cited by 41 publications

References 51 publications

How We Do It: A Multidisciplinary Approach to ¹⁷⁷Lu DOTATATE Peptide Receptor Radionuclide Therapy

How We Do It: A Multidisciplinary Approach to ¹⁷⁷Lu DOTATATE Peptide Receptor Radionuclide Therapy

Patient Travel Concerns After Treatment with ¹⁷⁷Lu-DOTATATE

Laboratory, Clinical, and Survival Outcomes Associated With Peptide Receptor Radionuclide Therapy in Patients With Gastroenteropancreatic Neuroendocrine Tumors

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Therapy With 177Lu-DOTATATE: Clinical Implementation and Impact on Care of Patients With Neuroendocrine Tumors

Cited by 41 publications

References 51 publications

How We Do It: A Multidisciplinary Approach to 177Lu DOTATATE Peptide Receptor Radionuclide Therapy

How We Do It: A Multidisciplinary Approach to 177Lu DOTATATE Peptide Receptor Radionuclide Therapy

Patient Travel Concerns After Treatment with 177Lu-DOTATATE

Laboratory, Clinical, and Survival Outcomes Associated With Peptide Receptor Radionuclide Therapy in Patients With Gastroenteropancreatic Neuroendocrine Tumors

Contact Info

Product

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Therapy With ¹⁷⁷Lu-DOTATATE: Clinical Implementation and Impact on Care of Patients With Neuroendocrine Tumors

How We Do It: A Multidisciplinary Approach to ¹⁷⁷Lu DOTATATE Peptide Receptor Radionuclide Therapy

How We Do It: A Multidisciplinary Approach to ¹⁷⁷Lu DOTATATE Peptide Receptor Radionuclide Therapy

Patient Travel Concerns After Treatment with ¹⁷⁷Lu-DOTATATE