Lutathera
Lutathera (lutetium Lu 177 dotatate) is a radiopharmaceutical that’s used to treat adults and children ages 12 years and older with rare cancers known as neuroendocrine tumors (NETs) found in the digestive tract. It’s given as an injection through the vein at specific facilities with healthcare staff trained in using medications containing radiation. After each treatment with Lutathera (lutetium Lu 177 dotatate), you’ll need to keep yourself and others safe since there’s a chance you can expose others to radiation for a few days after each dose. Common side effects include nausea, vomiting, and fatigue.
What is Lutathera (lutetium Lu 177 dotatate)?
What is Lutathera (lutetium Lu 177 dotatate) used for?
Neuroendocrine tumors (NETs) in the digestive tract that are positive for the somatostatin hormone receptor
How Lutathera (lutetium Lu 177 dotatate) works
Lutathera (lutetium Lu 177 dotatate) is a radiopharmaceutical. It's a special type of somatostatin, a hormone naturally found in the body. In this version, somatostatin is combined with a radioactive chemical.
Lutathera (lutetium Lu 177 dotatate) works by attaching to the somatostatin receptor on the surface of tumor cells. Then, it enters the cell. Once inside, the radioactive part of the medication damages the cell, stopping the tumor from growing and spreading.
Drug Facts
What are the side effects of Lutathera (lutetium Lu 177 dotatate)?
Common Side Effects
- Nausea (65%)
- Vomiting (53%)
- Fatigue (38%)
- Stomach pain (26%)
- Diarrhea (26%)
- Lowered appetite (21%)
- Headache (17%)
- Dizziness (17%)
- Swelling in the arms and legs (16%)
Other Side Effects
- Flushing
- Back pain
- Anxiety
- Hair loss
- Cough
- Constipation
- Fever
- Changes in taste
- Muscle and neck pain
Serious Side Effects
- Serious allergic reaction: breathing problems, hives, rash, itchiness; swelling of the face, mouth, or lips
- Hormone gland problems: feeling hot or flushed, severe diarrhea, feeling weak or dizzy, breathing problems
- Low blood cell counts: fever, chills, feeling very tired, dizziness, unusual bleeding or bruising
- Bone marrow problems and blood cancers: feeling very weak or tired, bruising or bleeding easily, blood in the urine or stool, fevers, unexplained weight loss
- Kidney problems: making little or no urine, dark urine
- Liver problems: pain in the right side of the stomach, yellowing of the eyes or skin, dark or brown urine
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
- Flushing, diarrhea, dizziness, feeling faint or lightheaded, blurry vision, wheezing or trouble breathing
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- Infection—fever, chills, cough, or sore throat
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Lutathera (lutetium Lu 177 dotatate)
Pros
Treatment given once about every 8 weeks
Recommended option for certain neuroendocrine tumors in the digestive tract
Works by targeting specific cancer cells in the body
Cons
Radioactive treatment, so extra safety precautions are needed during and after treatment
Treatment can take several hours, plan to be there for half a day
Might cause kidney or liver problems
Pharmacist tips for Lutathera (lutetium Lu 177 dotatate)
Lutathera (lutetium Lu 177 dotatate) is a radiation treatment. At the treatment center, you’ll likely be in a separate area to prevent others from radiation exposure. Your treatment team will wear protective equipment and give you instructions on radiation safety for when you leave the clinic.
For the first few days after your Lutathera (lutetium Lu 177 dotatate) dose, wash your hands frequently, take a shower every day, use the toilet seat in the seated position, and wipe with toilet paper. These are important steps to take to minimize radiation exposure.
If you have caregivers who handle your bodily fluids or help you in the bathroom, they should wear disposable gloves for a few days after your Lutathera (lutetium Lu 177 dotatate) infusion.
Drink plenty of water and urinate frequently before, on the day of, and the day after treatment with Lutathera (lutetium Lu 177 dotatate). This helps prevent potential kidney damage from the radiation.
Before your Lutathera (lutetium Lu 177 dotatate) infusion, you’ll receive medication to prevent nausea and vomiting. You’ll also get an amino acid infusion to protect your kidneys.
It’s possible to have an allergic reaction to the Lutathera (lutetium Lu 177 dotatate) infusion. Let your treatment team know right away if you notice signs of an infusion reaction, like trouble breathing, itching, dizziness, chills, chest pain, or swelling of the mouth or lips.
Certain somatostatin medications can interfere with Lutathera (lutetium Lu 177 dotatate) if they’re taken too close together. So you’ll likely stop long-acting octreotide treatments at least 4 weeks before your first Lutathera (lutetium Lu 177 dotatate) dose. You can still use short-acting octreotide to help control your tumor symptoms if needed, but you shouldn’t use it within 24 hours before receiving Lutathera (lutetium Lu 177 dotatate).
You’ll need to take long-acting octreotide between 4 and 24 hours after each Lutathera (lutetium Lu 177 dotatate) dose.
Lutathera (lutetium Lu 177 dotatate) can harm unborn babies. If you’re a woman who’s able to become pregnant, make sure to use effective birth control while on treatment and for 7 months after your last last dose.
For men with partners who can become pregnant, continue using effective birth control while on treatment and for 4 months after your last Lutathera (lutetium Lu 177 dotatate) dose.
Avoid breastfeeding for 2.5 months after your last Lutathera (lutetium Lu 177 dotatate) dose.
Frequently asked questions about Lutathera (lutetium Lu 177 dotatate)
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What are the risks and warnings for Lutathera (lutetium Lu 177 dotatate)?
Lutathera (lutetium Lu 177 dotatate) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Radiation exposure
Since Lutathera (lutetium Lu 177 dotatate) is a radiation-based treatment, it can add to your overall radiation exposure over time. And higher total amounts of radiation exposure can raise risk for cancer. Talk with your provider if you’re concerned about radiation exposure, and precautions you can take to protect yourself and others during Lutathera (lutetium Lu 177 dotatate) treatment.
Serious allergic reactions
Serious allergic reactions can happen with Lutathera (lutetium Lu 177 dotatate). Notify your healthcare team if you have trouble breathing, chills, flushing, nausea, chest discomfort, or swelling in the mouth, lips, or throat during the infusion. They’ll pause the infusion and give you medication to manage your symptoms. If the reaction isn’t too serious, they might continue the Lutathera (lutetium Lu 177 dotatate) infusion and give you premedications to prevent reactions with future infusions.
Hormone gland problems (carcinoid crisis)
While rare, some people developed hormone gland problems after Lutathera (lutetium Lu 177 dotatate) treatment. Usually, this happens within 24 hours after the first Lutathera (lutetium Lu 177 dotatate) dose. If you have severe flushing, diarrhea, bronchospasm, or are feeling very lightheaded and dizzy, contact your healthcare team. They can check your symptoms and give supportive medications if needed.
Low blood cell counts (bone marrow suppression)
Lutathera (lutetium Lu 177 dotatate) affects your bone marrow and causes your body to make fewer blood cells. Low amounts of blood cells can raise your chance of bleeding and make you more likely to get infections. Talk to your healthcare provider right away if you suddenly have unusual bleeding or bruising, muscle weakness, changes in your speech and vision, or develop a fever.
Risk of bone marrow problems and blood cancers
In very rare cases, some people who received treatment with Lutathera (lutetium Lu 177 dotatate) developed a bone marrow problem called myelodysplastic syndrome (MDS), or cancer of the blood called acute leukemia. On average, people who developed these problems were diagnosed years after starting Lutathera (lutetium Lu 177 dotatate). Talk to your provider if you’re concerned about your risk for other cancers.
Kidney problems
Risk factors: History of kidney problems
Lutathera (lutetium Lu 177 dotatate) can harm the kidneys, especially if you have a history of kidney problems. Your treatment team will do a blood test to check that your kidneys are healthy before each treatment. To protect your kidneys, you’ll also receive amino acid infusions with each dose of Lutathera (lutetium Lu 177 dotatate). Drink plenty of water and urinate frequently before, the day of, and the day after Lutathera (lutetium Lu 177 dotatate) treatment to keep your kidneys working well. Let your provider know if you have little or no urine. That could be a sign of kidney problems, and you might have to temporarily delay treatment while your kidneys recover.
Liver problems
Risk factors: Liver tumors
Lutathera (lutetium Lu 177 dotatate) might cause damage to your liver. Let your healthcare team know if you notice signs of liver damage, such as pain in the right side of the stomach, yellowing of the eyes or skin, or dark or brown urine. Sometimes, people don’t feel any symptoms when their liver is having problems, so you’ll need to get regular blood tests done to track how well your liver is working during treatment.
Harm to the unborn baby
Lutathera (lutetium Lu 177 dotatate) can harm unborn babies. If you’re able to become pregnant, your provider will have you do a pregnancy test. Use effective birth control while taking this medication and for at least 7 months after your last dose. For men with partners who are able to become pregnant, continue using effective birth control while taking Lutathera (lutetium Lu 177 dotatate) and for at least 4 months after the last dose.
Fertility problems
Lutathera (lutetium Lu 177 dotatate) might cause infertility. This is because radiation can be absorbed by your testes or ovaries. Let your provider know if you or your partner are planning to become pregnant.
Lutathera (lutetium Lu 177 dotatate) dosage forms
Typical dosing for Lutathera (lutetium Lu 177 dotatate)
The typical dose is 7.4 GBq given as an injection through the vein about every 8 weeks for a total of 4 doses.
Between 4 to 24 hours after each Lutathera (lutetium Lu 177 dotatate) dose, you’ll need to use long-acting octreotide (Sandostatin LAR).
Note: GBq is a unit of radioactivity. Since this medication works by delivering radiation, the dose is described using units that measure radioactivity.
What are alternatives to Lutathera (lutetium Lu 177 dotatate)?
Neuroendocrine tumors (NETs) in the digestive tract that are positive for the somatostatin hormone receptor
Breast cancer (hormone receptor-positive, HER2-negative)
Neuroendocrine tumors (NET)
Kidney cancer (renal cell cancer or RCC)
Tuberous sclerosis complex (TSC)-associated kidney tumor
Tuberous sclerosis complex (TSC)-associated brain tumor (people age 1 years and older)
Tuberous sclerosis complex (TSC)-associated seizures (people age 2 years and older)
Lutathera (lutetium Lu 177 dotatate) images
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References
Best studies we foundAdvanced Accelerator Applications USA, Inc. (2023). Lutathera- lutetium lu 177 dotatate injection [package insert]. DailyMed.
American Cancer Society. (n.d.). Targeted therapy.
American Cancer Society. (2019). Radiation therapy safety.
American College of Radiology. (2020). ACR-ACNM-ASTRO-SNMMI Practice parameter for lutetium-177 (lu-177) dotatate therapy.
Memorial Sloan Kettering Cancer Center. (2022). About your Lutathera® treatment.
Munjal, A., et al. (2023). Radiopharmaceuticals. StatPearls.
National Cancer Institute. (2020). Hair loss (alopecia) and cancer treatment.
National Comprehensive Cancer Network. (2022). Neuroendocrine tumors.
Novartis Pharmaceuticals Corporation. (2024). Radiation safety.
Novartis Pharmaceuticals Corporation. (2024). Understanding Lutathera.
O’Toole, T. J., et al. (2023). Physiology, somatostatin. StatPearls.
Pandit, S., et al. (2023). Carcinoid syndrome. StatPearls.
Strosberg, J., et al. (2017). Phase 3 trial of 177lu-dotatate for midgut neuroendocrine tumors. The New England Journal of Medicine.
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