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Lutathera, also known as lutetium Lu 177 dotatate, is a medicine that uses radiation to kill cancer cells. It consists of two parts: a tumor-targeting part that attaches to specific receptors (somatostatin receptors) on tumor cells, and a radioactive part that kills cancer cells. Lutathera has been used in Europe for over 20 years and was approved by the U.S. Food and Drug Administration, in 2018, to treat gastroenteropancreatic neuroendocrine tumors.
Lutathera is given in four doses, spaced eight weeks apart. Each treatment takes approximately five to six hours. An intravenous (IV) line is started and then pre-medications, consisting of IV fluids, anti-nausea medications, and amino acids, are administered. Following the predmedications, Lutathera is administered over 45 minutes. The amino acids continue to run for up to four hours after the treatment is complete. The amino acids reduce the radiation exposure to the kidneys from the Lutathera. Finally, an injection of Lanreotide is given to offset flushing and diarrhea, which is a side effect of neuroendocrine carcinoma.
As with most cancer treatments, Lutathera has the potential for both immediate side-effects and long-term complications. Immediate side effects include fatigue, hair thinning, nausea, decreased blood cell counts, increased liver enzymes, decreased blood potassium levels, and increased glucose in the bloodstream. Conditions that may occur soon after treatment are Tumor Lysis Syndrome (a condition caused by debris of dead tumor cells and induces flu-like symptoms), and, rarely, Carcinoid Crisis (a condition caused when high levels of hormones are liberated from tumor cells).
Long-term complications include a two percent or lower chance of Myelodysplastic Syndrome and Acute Myelogenous Leukemia, which are diseases affecting the bone marrow. Kidney problems are possible, but uncommon. However, patients with previous kidney impairment may be at a higher risk for kidney problems after Lutathera. Liver injury occurs in less than one percent of Lutathera patients and includes tumor bleeding, swelling, or tissue injury.
No permanent lifestyle changes are necessary after Lutathera treatment. Medications and diet should resume as normal. Increased fluid intake immediately following treatment will help to flush radioactive waste from the body and promote healthy kidney function.
During Lutathera treatment, patients are kept away from other patients and visitors. Family members and caregivers are allowed to be with patients during treatment but are asked to leave for the 45 minutes while Lutathera is being given. After leaving NCS, patients should avoid close contact with children and pregnant women for two weeks. Daily showering is recommended for at least the first few days after receiving Lutathera. While using the toilet for a few days after Lutathera, both men and women should be in the seated position, the toilet should be flushed twice, and good hand hygiene should be practiced. Breastfeeding should not occur during or for 2.5 months after Lutathera treatment. Contraception should be used for 7 months after the final Lutathera treatment.
Most insurance plans pay for Lutathera, including Medicare sponsored health care plans. Financial assistance may be available to some patients through a patient assistance program called AAA PatientCONNECT, which is sponsored by the company that manufactures Lutathera, Advanced Accelerator Applications. A complete insurance review is done by NCS’ prior authorization team prior to therapy initiation.
Lutathera is provided at Nebraska Cancer Specialists’ (NCS) Theranostic Clinic, located at 17201 Wright Street, Suite 203, Omaha, NE, 68130.
The NCS Theranostics team works to optimize patient outcomes in partnership with each patient’s medical oncologist, primary care provider, and any other specialized physicians or advance practice professionals who are currently treating the patient.
The NCS Theranostics program is committed to delivering high-quality patient care. We welcome and encourage questions at any time. Please call 402-334-4773 and ask for the Theranostics Nurse Case Manager.