Management of Hormonal Crisis in Patients Undergoing Lutetium-177-Dotatate (Lutathera) Therapy.

Objectives: 1. Learn the possible side effects of Lutathera therapy. 2. Increase awareness of the clinical presentation and consequently early recognition of hormonal crisis in patients undergoing Lutathera therapy. 3. Review risk factors associated with occurrence of hormonal crisis in Lutathera therapy. 4. Discuss the clinical management of hormonal crisis in Lutathera therapy. DISCUSSION: Lutetium-177-Dotatate is a radiolabeled somatostatin analogue recently approved by the Food and Drug Administration for peptide receptor radiolabeled therapy of certain neuroendocrine tumors. This educational exhibit will review the rare but severe complication of hormonal crisis associated with Lutathera therapy. The discussion will include the clinical presentation, time course and management of hormonal crisis. It will also include a review of factors associated with occurrence of hormonal therapy which may be early indicators of increased risk of hormonal crisis in certain patients. Finally, we will give a brief review of our center’s experience regarding complications of Lutathera therapy.

Conclusions: Lutetium-177-Dotatate has shown promising results in the management of gastrointestinal neuroendocrine tumors. Sound knowledge of complications and management is important for the nuclear medicine physician to reduce incidence of adverse outcomes in patients undergoing therapy. REFERENCES: 1. U.S. Food and Drug Administration: Approved Drugs. FDA approves lutetium Lu 177 dotatate for treatment of GEP-NETS. January 26, 2018. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm594105.htm. Accessed January 8, 2019. 2. Strosberg J, El-Haddad G, Wolin E, Hendifar A, Chasen B, Mittra E, et al. Phase 3 trial of 177Lu-dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376:125-35. 3. de Keizer B, van Aken MO, Feelders RA, et al. Hormonal crises following receptor radionuclide therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate. Eur J Nucl Med Mol Imaging. 2008;35(4):749-55. 4. Gut P, Waligórska-Stachura J, Czarnywojtek A, et al. Management of the hormonal syndrome of neuroendocrine tumors. Arch Med Sci. 2016;13(3):515-524.