Peptide Receptor Radionuclide Therapy (PRRT)

for Octreotide Avid Tumours

What is this cancer?
You have been diagnosed with a Neuroendocrine Tumour. This tumour
developed from the hormone-producing cells in your body that began to
divide and multiply without control and eventually formed a growth of
abnormal tissue called a tumour.
Neuroendocrine tumours can be functional meaning they produce EXCESS
hormones or non-functional meaning they DO NOT produce excess hormones.
It is the excess hormone released into the bloodstream that causes
individuals to feel unwell.

How can this cancer be treated?

Most Neuroendocrine Tumours have special receptors that attach to a
naturally occurring hormone that we all produce called somatostatin.
Octreotide is able to attach to these receptors.
177-Lutetium is a targeted therapy, meaning it attacks the tumour directly.

Will 177-Lutetium-Octreotate cure my cancer?

This treatment will not cure the cancer. It can be very effective in decreasing
tumour size or it may stop its growth. It does not seem to matter if the
tumour deposits shrink or stay the same size, there is benefit in both cases.

JUST DIAGNOSED

177-Lutetium-Octreotate Therapy

Precautions to be taken
177-Lutetium is radioactive and is not given if you are pregnant. If there any
concerns about pregnancy, a pregnancy test will be done. Reliable birth
control should be used until treatment has finished and for at least 6 months
afterward. Men are advised not to father a child for the same period.
If you are breast-feeding, you must tell your doctor. Breast-feeding must stop
before you have this treatment.

What should I do if my Sandostatin LAR is due near

my treatment date?
We do not want your Sandostatin LAR to be given 48 hours prior to your
Lutetium therapy. It can be given 3 days after the treatment. Your visiting
nurse will require an order from the doctor to change the day. We can help
you rearrange the date if necessary. Please inform your nurse of any conflict.

What needs to be done before my treatment?

There are three scans that need to be done before you have your first
treatment. You will require a CT scan or MRI, renal scan, and an In111
Octreotide scan. Only the neuroendocrine tumours where In111 Octreotide
attaches to the tumour will be considered for this therapy. A renal scan is
necessary because the excess 177-Lutetium passes through the kidney and is
excreted in the urine. A CT or MRI is required as a baseline to determine the
efficacy of the therapy.
You must STOP all herbal preparations, vitamin C and E one week prior to the
treatment. These are not to be resumed until after all therapy is completed.
These agents can potentially inhibit the effectiveness of the treatment.

Who does the therapy and where is it given?

The 177-Lutetium-Octreotate therapy is administered by a Nuclear Medicine
physician. The therapy days are Monday and Tuesday.

When treatment is scheduled on a Monday, you will be evaluated in the

Cancer Centre on Thursday. On the Sunday, between 2:00 pm and 3:00 pm,
you must report to the admitting department where you will be directed to
C-7, the oncology floor. On Tuesday morning, when the radiation reading in
your body is at an acceptable level, you will be discharged to the Nuclear
Medicine Department for the post therapy scan. You may go home after this
scan is complete.
When treatment is scheduled on a Tuesday, you will be evaluated in the
Nuclear Medicine Department. Your appointment will be 8:15 am. Bloodwork
will be done and you will be evaluated by our physicians. The next step is to
report to admitting where they will advise you when the bed will be available
for your treatment. The 177-Lutetium will be administered later that
afternoon. On Wednesday morning, when the radiation reading in your body
is at an acceptable level, you will be discharged to the Nuclear Medicine
Department for the post therapy scan.
177-Lutetium is administered in the hospital intravenously (IV) over 30-45
minutes. In the future, we may be able to administer the 177-Lutetium as an
outpatient in the Nuclear Medicine Department.

Day of 177-Lutetium Therapy

You must drink 6-250 mL cups of fluid. This can be water, juice, milk,
carbonated decaffeinated beverages, decaffeinated coffee or tea, Boost,
Ensure, or Gatorade. An IV will be started about one hour before your
therapy. You will receive a mixture of amino acids which helps flush the
radioactivity from your kidneys and helps protect your kidneys.
The 177-Lutetium will be administered IV after that hour and will take 30-45
minutes. The amino acids will continue until the entire volume is completed,
about 4-6 hours. The IV will continue for the next 8 hours to flush the kidneys
of any excess radioactivity. Once the IV is discontinued you must drink 1-250
mL cup of fluid every hour for the next 2 hours. The following morning you
must drink 1-250 cup of fluid each hour, for the next 3 hours.

After the 177-Lutetium has been administered, the door to your room will be
closed and there will be minimal nursing care provided. You have a window, a
bathroom, and can rent a TV or telephone. This entire process will take 8-10
hours.
Visitors are restricted to a maximum of three 30 minute visits every 24 hours
for the same visitor. They must stay 1-2 meters from your bed. No physical
contact is permitted.

How will I feel after the treatment?

177-Lutetium therapy is often referred to as targeted therapy because of the
way it attaches to the receptors on the tumour. A very small amount of
normal tissue is exposed to radiation so side effects are minimal.
Some individuals will experience nausea and vomiting during or shortly after
the actual administration of 177-Lutetium. This can easily be managed while
you are in hospital and anti-nausea medication can be provided upon
discharge. It has been reported that some individuals have a decreased
appetite for 7-14 days post therapy. It is important you drink 8-10 cups of
fluid daily if this occurs.
There may be an increase or symptom of abdominal pressure, fullness for up
to 7 days after the treatment is administered. Pain is commonly due to
tumour lysis (breakdown, destruction of the cancer cells). If the pain has not
returned to the level of pain you normally experience, you must call your
health care team. Your weekly blood tests may also provide information as to
the cause of pain (the liver test results may be elevated).
It has been reported there may be some hair loss. This is usually mild and
regrowth of hair occurs after finishing therapy. This is not like with some IV
chemotherapy where there is significant hair loss.

Discharge Day
A staff member from Nuclear Medicine will come to your room to measure
the radiation levels by 9:00 am. Your door will be opened and you will be
discharged from the inpatient unit to the Nuclear Medicine department where
a post therapy scan will be done. This scan will take at least 90 minutes.

A radiation safety instruction information sheet will be given to you by

Nuclear Medicine. It is recommended for the first 48 hours after treatment
you double flush the toilet after use, also practice good hand washing. You
must avoid sexual intercourse and kissing for 48 hours. You must wait for 24
hours after treatment to be in close contact with infants and children. There
are no restrictions with pregnant women.
You will be given a Ministry of Health requisition for weekly blood tests. They
are to be done at a private lab close to your home. The results are sent weekly
to the Cancer Centre and reviewed. If there are concerns you will be notified
by your doctor or nurse.
Ensure that you receive a wallet size card that documents the type of
radiation received and the dose. This information is required if you plan to
cross the border into the United States.
You will not be going back to the inpatient unit. Take all your belongings
with you to Nuclear Medicine. Make arrangements to meet your ride at
London Health Sciences Centre.

After Discharge
For the first 6 weeks after your treatment, it is recommended you tell any
doctor, nurse or pharmacist you have been treated with 177-LutetiumOctreotate. It is recommended you carry this information brochure and the
radiation card with you at all times. This information will help answer
questions you may be asked.
We plan to administer three 177-Lutetium therapies. They will be
administered every 8-10 weeks based on your blood work results. We will
inform you of the tentative date for the next therapy the day of admission.
Three to four months after the third therapy, a CT scan or MRI and a renal
scan will be arranged to assess the efficacy of the therapy and your kidney
function. You will be provided with a clinic appointment. It is at this
appointment you will receive the results and the next step in your plan of care
will be discussed.

Note
177-Lutetium-Octreotate does not have a license for use in Canada. It is only
available through the Special Access Program with Health Canada. This means
that the results of the rigorous tests with respect to the efficacy of 177Lutetium, side effects, and which patients with neuroendocrine tumours are
more likely to benefit, have not yet been completed.
By law we must obtain your written consent to accept 177-Lutetium
Octreotate therapy. A member of your health care team will discuss the risks,
benefits and alternative treatments with you. If you have any questions about
the treatment, do not hesitate to ask to speak with your physician.

Recommended Lodging
If you need to stay in London the night prior to your admission we
recommend the Country Inn & Suites. They are located almost directly across
from the B Entrance into the London Health Sciences Centre. You can walk
from their parking lot to the hospital. There is a complimentary breakfast
included. They also have special rates for individuals who require the services
of London Health Sciences. As of September 2012, the rate per night for 2
people is $89.00.
www.countryinns.com/london
744 Baseline Road East
1.800.456.4000

NS6741 (2011/11/09) Updated December 20 012