Lutetium-177 Octreotate Therapy, Neuroendocrine Tumours, What to Expect, Patient Journey, Theranostics, Theranostics Singapore, Cancer Treatment, Dr Andrew Tan

What Is Lutetium-177 Octreotate Therapy? 

One of the therapies used to treat neuroendocrine tumours is Lutetium-177 Octreotate Therapy. It is a targeted radioligand therapy that specially targets tumours that express somatostatin receptors (i.e. neuroendocrine tumours). 

Its method of action consists of using peptide molecules such as artificial octreotate – transport – linked to a carrier agent for radioisotopes such as Lu-177 that destroy cancer cells.

What Are Neuroendocrine Tumours (NETs)?

Neuroendocrine tumours are cancers that arise from very specialised cells in the body (neuroendocrine cells). These cells have similar traits to nerve cells and hormone-producing cells. They are rare tumours and can appear in the lungs, pancreas, appendix, small intestine, and rectum.

Some produce hormones excessively (functional neuroendocrine tumours), while others produce little to no hormones (non-functional neuroendocrine tumours).

What to Expect Before Treatment With Lutetium-177 Octreotate Therapy?

If you have been diagnosed with a neuroendocrine tumour, our doctor shall do the pertinent assessment to corroborate the disease and determine the exact stage of the disease.  

Among the laboratory tests, you can expect to require a complete blood count, 24h creatinine clearance, chromogranin A, kidney, and liver function test.

In addition – before starting the treatment – a PET scan with gallium octreotate shall be carried out. This will determine the extent of the disease as well as the somatostatin receptor density on the tumours. 

Then, our doctor will explain the procedure as well as the possible side effects, together with all the recommendations that you should know after applying the treatment.

What to Expect During Treatment With Lutetium-177 Octreotate Therapy?

This type of therapy can be performed on an outpatient basis in the nuclear medicine department. Before starting, the patient will be asked to consume an average of 1.5L of fluids.

A peripheral intravenous line is placed in the patient for the administration of the treatment, in conjunction with an antiemetic before the infusion of amino acid compounds.

Administration of amino acids will be 30 minutes before lutetium-177 octreotate accompanied by intravenous fluids. This stage of the procedure takes a couple of hours.

Lutetium-177 octreotate is then given as a slow, controlled infusion, which will last for approximately 20 minutes. After that, you must wait a couple of hours while the radioactivity decreases.

The entire treatment lasts approximately 4 to 6 hours, ranging from the preparation phase and the time spent waiting for the manifestation of side effects if any.

What to Expect After Treatment With Lutetium-177 Octreotate Therapy?

After the treatment, you may experience a series of varied symptoms, for which you will spend a couple of hours in the nuclear medicine department. The most common immediate side effect is nausea. 

The medical staff will be attentive to any manifestation outside of what is expected and will treat these side effects accordingly. 

Lutetium-177 octreotate therapy has been shown to increase progression-free survival and an increase in overall survival, with excellent safety profiles.

How Long Before I Can Be Discharged After Lutetium-177 Octreotate Therapy? 

Discharge from the nuclear medicine department will be after 6 to 8 hours on average after starting treatment. The reason behind this is to wait for radioactivity levels to decrease and for the side effects to subside.

The patient must go back to the nuclear medicine department for a full body scan and check on the progress of the treatment after 24 hours.

How Will I Feel After Lutetium-177 Octreotate Therapy? 

It is normal to experience several side effects since it is a radioactive treatment. 

Some possible side effects of Lutetium-177 Octreotate Therapy include: 

  • Nausea (usually counteracted with prophylactic treatment)
  • General fatigue and tiredness
  • Marrow suppression, leading to decreased platelet and red cell counts. This is usually transient and mild, but some patients may require a blood transfusion. 
  • Renal impairment 
  • Diarrhoea

Many of these symptoms are transitory. In the face of uncertainty, please consult our doctor.

Radiation Precautions of Lutetium-177 Octreotate Therapy

In general, the patients must follow a series of recommendations that we will mention below to avoid contamination to third parties:

  • The patient must keep well hydrated for two days after treatment. In other words, he must increase his fluid intake.
  • The radiotracer will be expelled in the urine in the next few days, so you must flush the toilet twice.
  • Avoid contact with pregnant women and children under five years of age – at least 6 feet apart – for at least a week after treatment. 
  • Normal activities can be resumed after a complete post-treatment body scan.

What Questions Should I Ask My Doctor?

Most individuals feel many fears when diagnosed with some type of cancer, so it is important to clarify each of your concerns. 

Below is a summary of questions (although there may be more):

  • What are my treatment options if I have a neuroendocrine tumour?
  • How many tests do I need to know if I am a candidate for Lutetium-177 Octreotate Therapy?
  • How long is the total duration of Treatment With Lutetium-117 Octreotate Therapy?
  • Is it really necessary to do a scan 24 hours after the infusion?
  • Will my overall survival increase after therapy?
  • What recommendations should you follow after treatment?
  • How long should I wait to be intimate with my partner?

In case of presenting discomfort or not feeling in a more optimal state of mind, always remember to call or go to our specialist. They will help you mitigate any discomfort through symptomatic treatments if necessary.