Use of approved Lu‐177 radiopharmaceuticals in patients with end‐stage renal disease: A review of the literature and proposed treatment algorithm

Author:

Trikalinos Nikolaos A.1ORCID,Kim Hyun2,Vijayan Anitha3,Amurao Maxwell4,Prasad Vikas5

Affiliation:

1. Department of Medical Oncology Washington University School of Medicine St. Louis Missouri USA

2. Department of Radiation Oncology Washington University School of Medicine St. Louis Missouri USA

3. Intermountain Kidney Services, Intermountain Health Murray Utah USA

4. Office of Radiation Safety Washington University School of Medicine St. Louis Missouri USA

5. Department of Nuclear Medicine Washington University School of Medicine St. Louis Missouri USA

Abstract

AbstractPeptide receptor radionuclide therapy (PRRT) can be a very useful treatment for patients with neuroendocrine neoplasms and metastatic castration‐resistant prostate cancer but it is routinely avoided in those with advanced kidney disease because it can adversely affect the renal function. Accordingly, no clear guidelines exist on the use of PRRT for patients on hemodialysis (HD). We performed a literature review to identify publications on HD patients who received PRRT with Lutetium‐177 (Lu177) Dotatate and Y‐90 and obtained information on Lu177 pharmacokinetics and early testing data from the manufacturer. We also perused the most recent North American Neuroendocrine Tumor Society (NANETS)/European Neuroendocrine Tumor Society (ENETS) recommendations. Seven relevant publications with a total of 15 patients were included. Patients received dose‐adjusted fractions of PRRT with HD occurring usually within 24 h. There were no immediate or long‐term serious adverse events attributed to the radioligand, although data was limited. Using available evidence and input from a multidisciplinary group, we have created an institutional workflow. Dose‐adjusted PRRT can be offered to patients undergoing HD under careful, multidisciplinary supervision.

Publisher

Wiley

Reference24 articles.

1. KunzPL BensonAB BodeiL et al.The phase 3 NETTER‐1 study of 177Lu‐DOTATATE in patients with midgut neuroendocrine tumours: updated progression‐free survival analyses.

2. US Food and Drug Administration.FDA approves lutetium Lu 177 dotatate for treatment of GEP‐NETS.https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-lutetium-lu-177-dotatate-treatment-gep-nets

3. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors

4. Safety of Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE in Neuroendocrine Tumor Patients with Chronic Kidney Disease

5. End-stage renal disease after treatment with 90 Y-DOTATOC

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