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THERANOSTICS in Neuroendocrine Tumors

Theranostics

177Lutetium-DOTATATE

Therapeutic radioactive doses for Neuroendocrine Tumors

Peptide-Receptor Radionuclide therapy (PRRT)

General Concept

  1. Neuro-endocrine tumors have somatostatin receptors on their surface.
  2. We perform diagnostic PET/CT study using 68Gallium-DOTATATE to detect tumors in the body and confirm presence of receptors on tumor cells.
  3. We then inject the therapeutic dose (177Lutetium-DOTATATE). 177Lutetium emits short ranged Beta rays of average length of 0.23mm leading to tumor cell damage and at the same time low risk to surrounding healthy cells.

How it works?

  • The therapy is indicated in patients with metastatic neuroendocrine tumors (grade 1 and grade 2).
  • The treatment is composed of 4 intra-venous doses, one dose every 2 months.
  • It is performed as an outpatient procedure; the whole process takes about 4-5 hours.

Post procedure radiation safety:

  • Patients should be encouraged to drink large quantities of water in first 2 days (1 glass every 2 hours).
  • For the first 3 days:
    • Restricted contact with adults to a maximum of 6 hours per/day of close contact <1 meter.
    • Avoid contact with children and pregnant women (then restricted contact for further 3 days).

What is the eligibility criteria?

  • High somatostatin receptor expression based on Gallium-DOTATATE PET/CT scan.
  • Adequate bone marrow, renal and hepatic functions.
  • Avoid administering long acting octreotide for 4 weeks prior to therapy.
  • Exclude urinary outflow obstruction.

What are the expected results?

  • The results of NETTER-1 trial showed that 177Lu-DOTATATE had a 79% reduction in risk of progression.
  • Estimated progression free survival of 40 months, compared with only 8.4 months for high-dose (60mg) octreotide therapy.

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