Lutetium Lu 177 dotatate (Lu-177; Lutathera®) is a peptide receptor-binding radionuclide approved by the FDA in 2018 to treat hormone receptor somatostatin-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). It is also undergoing research and development as an investigational treatment of neuroblastoma, small-cell lung cancer, and somatostatin-receptor-positive small bowel carcinoid tumors. Because Lu-177 is a radioactive agent, cancer centers must develop and implement interdisciplinary procedures for its safe administration, protecting patients and staff from inadvertent exposures. Nurses have several roles in these interdisciplinary teams: patient education, establishing peripheral IV access, amino acid infusion, and symptoms management.
A multidisciplinary team approach is critically important for ensuring radiation safety in the administration of lutetium Lu 177 dotatate (Lu-177).1-3 Lu-177 has been used in Europe for several years but was only approved by the US Food and Drug Administration (FDA) in January 2018.4,5 Because this agent is a newly FDA-approved radionuclide therapy, US cancer centers that will offer this treatment are in the process of developing and implementing safety procedures.
Neuroendocrine tumors were once considered rare, but they are currently the second most-frequently occurring gastrointestinal malignancy.2 They usually emerge in the gastrointestinal tract or lungs.2,3 Somatostatin-positive gastroenteropancreatic neuroendocrine tumors are a rare and challenging group of cancers that occur in the pancreas and gastrointestinal tract tissues, including stomach, intestines, colon, and rectum. GEP-NETs are diagnosed in an estimated 1 person per 27,000 Americans each year, according to the FDA.4
A peptide receptor radionuclide therapy (PRRT), Lu-177 can be administered in outpatient treatment settings.3 Nuclear imaging of neuroendocrine tumors involves somatostatin receptor analogues that bind to somatostatin receptors on tumor cell surfaces. Lu-177 is very similar but it carries a radiotherapeutic payload.6 Lu-177 was approved by the FDA for treatment of GEP-NETs after being fast-tracked for Priority Review as a breakthrough therapy.4
Oncology nurses will play important roles in the safe administration of Lu-177, according to Kristyn Romanowski, BSN, RN, OCN, who reported on the Rocky Mountain Cancer Centers’ development of a safe outpatient administration process at the Oncology Nursing Society (ONS) 44th Annual Congress, held in Anaheim, California.3 The first of these tasks is to make sure patients understand the goals of treatment and the administration process.
“The nurse is responsible for the [Lu-177] education,” Ms Romanowski told Oncology Nurse Advisor. “We have a teaching session the week of treatment and discuss what to expect on the day of treatment, and after-care instructions.”
Because Lu-177 can harm a developing fetus and newborn, contraindications include pregnancy or ongoing lactation, as well as impaired hematologic function, severe renal impairment (creatinine clearance <30 mL/min), severe liver function impairment, severe cardiac impairment, moderate or severe right-heart valvular disease, or cognitive impairment impairing the patient’s ability to consent to treatment.7 Other patient eligibility criteria include sufficient bone marrow reserves, hemoglobin greater than 8.0 g/dL, white blood cells at more than 2000/mL, absolute neutrophil count higher than 1000, serum albumin greater than 3.0 g/dL, kidney function (serum creatinine clearance >30 mL/min; glomerular filtration rate [GFR] >40 mL/min/1.73m2), Karnofsky performance status higher than 50%, expected survival exceeding 3 months, and informed consent by the patient.7