Neuroendocrine Tumor Lu-177-Dotatate Therapy

Excerpt

Lutetium-177 (¹⁷⁷Lu)-dotatate is a treatment modality used to manage and treat neuroendocrine tumor patients. Neuroendocrine tumors (NETs) are a heterogeneous group of malignancies characterized by various presentations associated with indolent biological behavior. These tumors arise from neuroendocrine cells that are distributed in several areas of the body. Lutetium-177 (¹⁷⁷Lu)-dotatate therapy or peptide receptor radioligand therapy (PRRT) is indicated for treating gastroenteropancreatic neuroendocrine tumors and NET of the prostate gland. The FDA approved ¹⁷⁷Lu-dotatate therapy in 2018 to treat somatostatin receptor (SSTR) positive gastroenteropancreatic neuroendocrine tumors. Most NETs show relatively high expression levels of SSTRs, which allows imaging and therapy using radiolabeled somatostatin analogs. ¹⁷⁷Lu is a commonly used radionucleotide for targeted radiation therapy. The combination of radionucleotide ¹⁷⁷Lu with somatostatin analog dotatate delivers ionizing radiation targeting tumor cells that express somatostatin receptors, causing radiation-induced single and double-stranded DNA breaks leading to apoptosis. This activity reviews the indications, action, and contraindications for ¹⁷⁷Lu-dotatate therapy as a valuable agent in the management of neuroendocrine or carcinoid tumors. This activity will highlight the mechanism of action, adverse event profile, and other key factors pertinent for members of the interprofessional, multidisciplinary teams involved in managing patients with advanced neuroendocrine tumors.