Guidance on 177Lu-DOTATATE Peptide Receptor Radionuclide Therapy from the Experience of a Single Nuclear Medicine Division

J Nucl Med Technol. 2018 Sep;46(3):237-244. doi: 10.2967/jnmt.118.209148. Epub 2018 Aug 3.

Abstract

177Lu-DOTATATE is a radiolabeled somatostatin analog that has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors in adults. Radionuclide therapies have been administered for many years within nuclear medicine departments in North America. However, in comparison to other radiotherapies, 177Lu-DOTATATE peptide receptor radionuclide therapy involves more planning, coordination, concomitant medication administration (antiemetic medications and amino acids), and direct patient care. To date, various methods have been used in multiple centers during the NETTER-1 trial and the provision of patient care. As participants in the phase 3 NETTER-1 trial and the subsequent expanded-access program for the administration of 177Lu-DOTATATE studies, as well as recently starting postapproval clinical care, we have administered 61 177Lu-DOTATATE therapies at the time of this manuscript submission (13 in the NETTER-1 trial, 39 in the expanded-access program, and 9 clinically) at the Dana-Farber Cancer Institute and here share our procedures, personnel training, and workflow to help other centers establish programs for this FDA-approved 177Lu-DOTATATE peptide receptor radionuclide therapy.

Keywords: 177Lu-DOTATATE; neuroendocrine tumor; nuclear medicine; peptide receptor radionuclide therapy (PRRT); radionuclide therapy.

MeSH terms

  • Consent Forms
  • Humans
  • Intestinal Neoplasms / metabolism
  • Intestinal Neoplasms / radiotherapy
  • Neuroendocrine Tumors / metabolism
  • Neuroendocrine Tumors / radiotherapy
  • Nuclear Medicine* / legislation & jurisprudence
  • Octreotide / analogs & derivatives*
  • Octreotide / therapeutic use
  • Organometallic Compounds / therapeutic use*
  • Pancreatic Neoplasms / metabolism
  • Pancreatic Neoplasms / radiotherapy
  • Practice Guidelines as Topic*
  • Radiotherapy / methods*
  • Receptors, Somatostatin / metabolism*
  • Stomach Neoplasms / metabolism
  • Stomach Neoplasms / radiotherapy

Substances

  • Organometallic Compounds
  • Receptors, Somatostatin
  • lutetium Lu 177 dotatate
  • Octreotide

Supplementary concepts

  • Gastro-enteropancreatic neuroendocrine tumor