Considerations and approach prior to treatment with 177Lutetium DOTATATE Radionuclide Therapy

Introduction: 177Lutetium DOTATATE is the first FDA approved peptide receptor radionuclide therapy (PRRT). It was approved in 2018 for the treatment of somatostatin receptor positive gastroenterohepatic neuroendocrine tumors (NETs). 177Lutetium DOTATATE is a radioactive isotope bound to a somatostatin analog (DOTATATE) which binds somatostatin receptors with high specificity allowing for targeted radiation therapy. Neuroendocrine Tumors (NETS), certain neoplastic processes, and several organs highly express somatostatin receptors. As with other radionuclide therapies, there are special considerations and preparations needed prior to treatment. These include appropriateness of treatment, patient safety, and radiation safety. Our institution follows a structured approach for evaluation and treatment with 177Lutetium DOTATATE.

Methods: Appropriateness of treatment is evaluated using a multidisciplinary approach including endocrine oncology, nuclear medicine, gastroenterology, and other consulting services such as nephrology. Presentation at a multidisciplinary tumor board is routinely used for complex cases. Patients deemed appropriate to proceed are extensively counseled prior to treatment.

Results: Patient safety is carefully addressed using a checklist approach during counselling sessions both prior to initial therapy and during subsequent therapy sessions. Patient safety considerations include evaluation of performance status, history of radiation, interacting medications, tumor burden and surrounding structures, kidney disease, liver disease, and bone marrow disorders.

Radiation safety is also addressed during counselling sessions. This is focused on expected side effects, hygiene related to excretion of radioactive waste, and guidelines regarding limited contact with others while the patient is undergoing treatment.

Conclusions: At our institution, important concerns regarding appropriateness of treatment, patient safety, and radiation safety are addressed by using a structured checklist approach prior to treatment with 177Lutetium DOTATATE.