Administration of 177Lu-PSMA-617 as Compared to 177Lu-Dotatate

Document Type

Conference Proceeding

Publication Date

6-1-2022

Publication Title

Medical Physics

Keywords

lutetium 177, vipivotide tetraxetan lutetium lu 177, adult, clinical article, clinical protocol, conference abstract, controlled study, drug combination, drug safety, drug therapy, female, human, male, pharmacokinetics, phase 3 clinical trial, radiation safety, syringe, total quality management, workflow

Abstract

Purpose: Recent advances in nuclear medicine therapy include the use of 177Lu-labeled compounds for peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumors with 177Lu-Dotatate and metastatic prostate cancer with 177Lu-PSMA-617. Here we present the clinical workflow, quality management and radiation safety considerations for administration of 177Lu-PSMA-617 and compare to 177Lu-Dotatate. Methods: 177Lu-PSMA-617 has been conducted at our institution under expanded access use and phase III clinical trials since fall of 2021. Prior to implementation of the 177Lu-PSMA-617 therapy protocols, our institution had been performing 177Lu-Dotatate routinely for over 2 years. The clinical workflow, quality management program, and radiation safety protocols developed at our institution for 177Lu-PSMA-617 therapy utilized our experience with 177Lu-Dotatate, and knowledge of the difference between 177Lu-PSMA-617 and 177Lu-Dotatate. Both workflows include pre-administration and residual assays of the drug vial, syringe and IV lines. Additionally, post-therapy exposure rate measurements and posttherapy imaging were performed for all patients receiving 177Lu-PSMA-617 and 177Lu-Dotatate at our institution. Results: 177Lu-PSMA-617 workflow required consideration for several factors, including patient preparation prior to, during and after administration, pharmacokinetics and biological clearance rates. of 177Lu-PSMA-617 vs 177LuDotatate. 8 treatments of 177Lu-PSMA-617 (4 patients) and 29 treatments of 177Lu-Dotatate (11 patients) were compared for variations in residual activity, patient exposure rates, and administered activity. Average administered activity was 189.2 +/-2.06mCi for 177Lu-PSMA-617 and 198.0 +/- 1.81mCi for 177Lu-Dotatate. Average residual activity was 1.97 +/- 1.13mCi for 177Lu-PSMA-617 and 3.07 +/- 0.61mCi 177Lu-Dotatate. Post-therapy exposure rates, measured at 1 meter from patients, were 2.43 +/- 0.37mR/hr 0.12mR/hr for 177Lu-PSMA-617 and 2.30 +/- 0.53mR/hr 177Lu-Dotatate. Conclusion: Small but important changes should be implemented when 177Lu-Dotatate clinical workflow is adapted for 177Lu-PSMA-617 therapy. The differences in clinical workflow for 177Lu-PSMA-617 and 177Lu-Dotatate patients stem from a variety of factors. Similar radiation safety protocols can be utilized for both therapies.

Volume

49

Issue

6

First Page

e811

Last Page

e812

Find It @ Sladen

Share

COinS