Introduction: Lutetium-177 Oxodotreotide (Lutathera) is a targeted molecular radiotherapy treatment for advanced, inoperable, progressive neuro-endocrine tumours. We present our experience of Lutathera therapy with particular focus on our experience implementing treatment as a day-case procedure, and assessment of adherence to treatment quality standards surrounding the administration.
Aims: To assess safety of Lutathera as a day-case treatment.
Methods: Patients were treated with a schedule of 7.4 GBq Lutathera repeated at approximately 2 month intervals for up to 4 cycles. All patients were admitted overnight following the first cycle but if well tolerated offered day-case treatment for subsequent cycles. Data were collected from computer and paper records. Indications for treatment, pre-treatment workup, treatment administration, and post-treatment monitoring were assessed.
Results: Eighty doses of Lutathera from November 2015 to July 2019 (41 doses since 1st January 2019). 35% were administered as day cases. Compared to inpatient treatment there were no significant differences in side effect profile following day-case administration versus overnight admission: fatigue (46% vs 35%, P=0.49), nausea (14% vs 25%, P=0.36), vomiting (0% vs 7.7%, P=0.15), and abdominal pain (0% vs 7.7%, P=0.15). There were five medical events requiring hospitalisation among over the 80 doses administered during the period of observation. Four of these followed administration of the 1st dose of Lutathera: flare of pain with severe nausea (day 2), lower GI bleed (day 48), pyelonephritis (day >28) and NSTEMI (day 28). One followed the third dose: bowel perforation (day 27). None followed day-case administration. This period of observation was more than 320 days for a full four cycles on average and it is unclear whether all of these admissions were related to therapy. The overall follow up period was short (mean 452 days), but survival appears excellent to date (96%). A number of patients with functional tumours and hormonal syndromes experienced significant improvement in related symptoms
Conclusion: In our experience administration of Lutathera is associated with a low rate of adverse events. The treatment can be safely administered on a day case basis.
02 Dec 2019
UK and Ireland Neuroendocrine Tumour Society