Peptide Receptor Radionuclide Therapy (PRRT)
PRRT is a molecular targeted therapy used to treat neuroendocrine tumors (NET). Molecular targeted therapies use drugs or other substances to identify and attack cancer cells while reducing harm to healthy tissue. PRRT delivers high doses of radiation to tumors in the body to destroy or slow their growth and reduce disease side effects.
Under the directorship of Dr. Ebrahim Delpassand, we have the highest experience in performing PRRT in patients with neuroendocrine tumors in the United States. We have been offering Lutetium-177 DOTATATE for patients with Somatostatin Receptor (SSTR) Expressing Neuroendocrine tumors since 2010 and have treated hundreds of patients with this rare cancer.
Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs)
Excel Diagnostics and Nuclear Oncology Center under the directorship of Dr. Ebrahim S. Delpassand has the highest experience in performing PRRT in patients with neuroendocrine tumors in the United States and treated hundreds of patient with this rare disease.
Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms that arise from Kulchinsky cells that populate the thymus, bronchus and gut. Regardless of their primary site, NETs share similar histological, metabolic and ultrastructural features. One of the hallmarks of differentiated (mature) neuroendocrine tumors is expression of Somatostatin Receptors (SSTR). This provides an excellent opportunity to detect this disease and also treat this cancer by reaching these receptors on the surface of tumor cells. Somatostatin analogues are group of small molecules (Peptide) that have affinity for SSTR and therefore upon intravenous administration are capable of detecting tumor cells throughout the body and attach to the receptors. Attachment of radio-isotopes such as Lu-177 or Y-90 to this small molecule (Peptide) creates a radiopharmaceutical that is capable of reaching to SSTR expressing tumors at the cellular level and deliver the therapeutic doses of radiation to the tumors anywhere throughout the body, in a targeted fashion. This is considered a personalized and targeted cancer therapy since it is directed to the malignant cells with high effectiveness and less and mostly reversible side effects.
Please contact our clinical coordinators, Ms. Susan Cork at firstname.lastname@example.org for further information and registration for this therapy.
LUTATHERA is a prescription medicine used to treat adults with a type of cancer known as gastroenteropancreatic neuroendocrine tumors
(GEP-NETs) that are positive for the hormone receptor somatostatin, including GEP-NETs in the foregut, midgut, and hindgut.
Lutathera is a radioactive targeted therapy via intravenous (IV) infusion. This means that it has 2 parts: a radioactive part and a tumor-targeted part. The tumor-targeted part helps the medication fight just the tumor cells. This helps keep the medication from damaging healthy parts of your body. The radioactive part uses radiation to damage and kill the tumor cells.
Planning Your Lutathera Treatment
Before you get Lutathera, you will have a consultation with one of our physicians. You may need to have a blood test before your appointment. If you do, our clinical coordinator will provide you with the details. During your consultation, you will be asked about your medical history and the goals of Lutathera treatment will be discussed. The physician will review your medical history and blood test results to determine if Lutathera is right for you.
You will also be asked about your medications. Make sure they know all the medications you’re taking, including patches, creams, prescription medications, and over-the-counter (not prescription) medications. You may need to stop taking some of them before your treatment. If it is determined that Lutathera treatment is right for you, the side effects and what to expect will be discussed with you during the consultation.
Lutathera treatment schedule
Lutathera treatment is given as 4 separate infusions. The infusions are given 8 weeks apart. Your last Lutathera infusion will be 24 weeks (about 5 and a half months) after your first infusion. Starting after your first Lutathera infusion, you will have a blood test every 2 weeks for 34 weeks (8 months). This is to make sure that your blood cell counts stay at their usual levels during your treatment. The timeline below shows your Lutathera treatment schedule.
You may be getting octreotide injections as part of your cancer treatment. If you get an octreotide injection too close before your Lutathera infusion, it can make the treatment less effective. Your doctor will give you more information.
- If you take long-acting octreotide, don’t take it for 4 weeks before each Lutathera infusion. You will visit your medical oncologist to get an injection of long-acting octreotide after each infusion.
- If you take short-acting octreotide (immediate-release octreotide), you can keep taking it during your Lutathera treatment. Don’t use short-acting octreotide for 24 hours before each Lutathera infusion, unless your doctor gives you other instructions.
Your Lutathera Infusion Appointments
Your infusion appointments will take all day. You should plan to arrive for your appointments by 8:30 am and leave around 5:00 pm. You may want to bring a book, portable music player, or other things to entertain yourself during your appointment. You can also bring food and a drink.
What to expect
In the therapy suite, you will have a private room with a recliner sofa, a TV and WiFi. A technologist will measure your vital signs and will place an IV line in your vein
You will get a few different medications during your infusion appointment.
- First, you will get antinausea medications. These are medications to keep you from vomiting or feeling nauseous.
- About 45 minutes after you get the antinausea medications, the technologist will connect an amino acid hydration solution to one of your IV lines. This is to protect your kidneys from the Lutathera. It will be infused slowly over 4 hours.
- About 30 minutes after the start of the amino acid infusion, the Lutathera will be connected to your other IV line. It will be infused over 30 minutes.
During and after the infusions, you may have:
- Abdominal pain or discomfort
A technologist will stay with you during your entire treatment to help with these if they happen.
Nuclear medicine scan
After the amino acid infusion is finished, you will have a short nuclear medicine scan to check where the Lutathera went in your body. You will be lying down during the scan. It will take about 5 minutes. After the scan, you may need to stay in the therapy suite for 2 to 3 hours. The timeline below shows what to expect during each of your Lutathera infusion appointments.
Radiation safety precautions
After your Lutathera infusion, there will be radiation coming from your body. A staff member will talk with you about your radiation safety precautions before you leave your appointment. They will also give you written instructions to follow at home.
Follow the radiation safety precautions below, as well as the instructions given to you, to keep from exposing other people to radiation.
- Don’t use public transportation to get home from your infusion appointment. It’s okay to take a taxi. If you drive home after your appointment and there’s another person in the car with you, sit as far away from them as you can.
- Avoid being in close physical contact with other people. It’s ok to be in close contact with another person for a short period of time (such as a brief hug), but you should stay at least 3 feet away from other people most of the time.
- Practice good hygiene, such as washing your hands well with soap and water after using the bathroom. Some of the Lutathera will be leave your body in your blood, urine, and other fluids.
The number of days you will need to follow these precautions is based on your specific Lutathera treatment. It can range from 2 to 11 days.
Some types of security equipment (such as at the airport ) can detect very small amounts of radiation. You will be given a card that says you received radioactive medicine and that you may give off small amounts of radioactivity for up to 1 month after your treatment. If you’re stopped by law enforcement at a checkpoint, show them this card.
If you have any questions about radiation safety, call 713-781-6200. ext 3224
After Your Lutathera Infusion Appointments
- Follow the radiation safety instructions that were given to you.
- Drink lots of liquids after each infusion. This will help the radiation leave your body more quickly.
- If you need to give blood, urine, or stool samples during the first 2 weeks after a Lutathera infusion, tell the staff member helping with the collection that you have been treated with radioactive Lutetecium-177.
If you take long-acting octreotide injections, you will see your oncologist to get a long-acting octreotide injection after each of your infusions.
During your Lutathera treatment
(from your first infusion until 6 months after your last infusion):
- Always use a condom during sexual activity
- Don't become pregnant
- Don't get a person pregnant
- Don't breastfeed
I131 Radioactive Iodine
I-131 radiotherapy is a treatment for hyperthyroidism and thyroid cancer. For thyroid cancer, I-131 radiotherapy typically follows surgery to remove the thyroid and is used to destroy any remaining cancerous or healthy thyroid tissue.
In I-131 radiotherapy, the radioactive material used is radioactive iodine I-131. The patient swallows the radioactive iodine in either liquid or pill form. The I-131 accumulates in the bloodstream and destroys the thyroid cancer cells.
Guidelines for I-131 Radiotherapy Patients
Small amounts of radioiodine can remain in the body for up to three months following treatment. Most of the radioiodine is eliminated from the body during the first week after treatment, primarily through urine. Very small amounts are expelled from the body in saliva, sweat and bowel movements. As a result, patients must observe certain precautions to minimize radiation exposure to others.
First 8 Hours Following Treatment:
- Drink one glass of water each hour and use the bathroom as soon as possible when you need to empty your bladder. Men should sit on the toilet to decrease splashing. Use a tissue to wipe up any urine on the toilet bowl and flush. Wash your hands.
- Maintain a minimum distance of 3 feet from all people. You should drive home alone, but if this is not possible, maintain as much distance as possible from other people in the car. You should not use public transportation.
First Two Days Following Treatment:
- Sleep alone.
- Do not share cups, glasses, plates or eating utensils. Wash items promptly after using them.
- Do not share towels or washcloths.
- Wash your towels, bed linens, underwear and any clothing stained with urine or sweat separately from other laundry
First Week Following Treatment:
- Arrangements should be made for others to care for infants and very young children.
- Avoid kissing and physical contact and maintain a distance of 3 feet or greater from women who are pregnant and minors under 18 years old.
- Avoid activities where you may be close to others for more than 5 minutes, for example, movie theaters, sporting events and public transportation.
The ZEVALIN therapeutic regimen is used to treat patients with:
- Recurring, low-grade or follicular B-cell NHL, after other anticancer drugs are no longer working.
- Newly diagnosed follicular NHL following a response to initial anticancer therapy.
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Xofigo® (radium Ra 223 dichloride) injection is indicated for the treatment of patients with castration-resistant prostate cancer (CRPC), symptomatic bone metastases and no known visceral metastatic disease.
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