Overview

This information is intended to answer your questions about having lutetium therapy. 

Lutetium therapy is a treatment for a group of rare cancers called neuroendocrine tumours. They can develop anywhere in the body, but often start in the bowel, pancreas gland or lungs.

A neuroendocrine tumour affects the cells that release chemical messengers called hormones into the bloodstream (neuroendocrine cells).

The information covers:

• how lutetium therapy works
• how you have the treatment
• the benefits of the treatment
• the risks of the treatment
• what you can expect when you come to hospital
• what happens after the procedure

If you have any more questions or concerns, please speak to a doctor or nurse caring for you.

How lutetium therapy works

Lutetium therapy is a type of cancer treatment called a targeted radionuclide therapy or peptide receptor radionuclide therapy (PRRT).

The treatment uses a medicine that is made of:

• oxodotreotide, which is a man-made (synthetic) version of a hormone made naturally in your body called somatostatin
• lutetium-177, which is a substance that releases radiation

We give you this combined medicine through a drip (as an infusion) into a vein. It travels through the body and binds to the surface of neuroendocrine tumours. The oxodotreotide makes sure that the lutetium gives a high amount (dose) of radiotherapy directly to the tumour.

The aims of lutetium therapy are to:

• slow down or prevent tumour growth
• help with some of the symptoms that the tumour causes

How you have the treatment

You usually have lutetium therapy as 4 treatment sessions, which are each 8 to 12 weeks apart.

Each lutetium therapy cycle typically involves 3 days of hospital appointments and may include an overnight stay in hospital. It takes 8 months to 1 year to complete all 4 treatment cycles.

After you have finished your last treatment cycle, your follow-up appointments take place over the next year. During that time, you keep in contact with the doctor who referred you for treatment or cancer specialist (oncologist) who is in charge of your overall care.

Benefits of the treatment

Research shows that lutetium therapy has various benefits for people who have neuroendocrine tumours. It can:

• increase life expectancy
• help with symptoms
• improve quality of life

Your doctor may recommend this treatment if you have a neuroendocrine tumour that is getting worse and has stopped responding to other treatment. They first need to check if lutetium therapy is a suitable treatment for you.

Risks of the treatment

If you have lutetium therapy, there are 2 main types of possible side effects. You may get side effects from:

• the treatment itself
• the radiation dose to your body

Side effects from the treatment

The treatment may cause the following side effects:

• It can make you feel sick (nausea). This usually only happens on the day that you have the treatment. We give you some anti-sickness medicine in advance to prevent this.
• It can cause increased pain due to inflammation of the tumour, especially if it is in your bones, liver or pancreas. This usually passes within 72 hours of the treatment. We prescribe a low dose of a steroid (anti-inflammatory) medicine called dexamethasone to help. You may also need to take your usual pain medicine more regularly.
• It may temporarily make your everyday symptoms get worse. These symptoms may include flushing, sweating, palpitations (a racing heartbeat), wheezing or diarrhoea. This usually settles within 24 to 48 hours. You may need to increase the amount of anti-diarrhoea medicine that you take.
• It may cause temporary hair thinning. Your hair will regrow normally when you have finished lutetium therapy.
• It can make you feel tired for a few weeks after each cycle of treatment. Your clinical nurse specialist talks to you about how you can manage any tiredness when you go home.

You may not get any of these side effects and feel the same after your treatment.

Side effects from the radiation dose

Lutetium therapy can affect parts of your body other than the tumour. In particular, it can affect your bone marrow (the soft, spongy tissue in the centre of your bones) and kidneys. For a few weeks after treatment, this can make you:

• feel more tired than usual
• become more vulnerable to infection

We arrange for you to have regular blood tests after each cycle of treatment. This allows us to:

• check your blood cells (blood count)
• see how your kidneys and liver are working

Your clinical nurse specialist talks to you about having the blood tests.

Side effects from the radiation can also include damage to healthy cells. However, these cells take in (absorb) very low amounts of lutetium compared with the tumour. There is a very low risk that this might:

• damage your bone marrow
• cause a secondary blood cancer in the future, several years after you have finished the lutetium therapy

It is important to tell your doctor or clinical nurse specialist if you have any new or unexpected health problems after lutetium therapy.

Lutetium and pregnancy

As lutetium therapy involves radiation, we do not give this treatment during pregnancy because it might harm a developing baby. 

We need to know if you are pregnant before starting treatment. To check this, we might ask you to give a urine sample before each lutetium therapy cycle. We can then use this sample to do a pregnancy test.

You need to sign a pregnancy declaration form when giving your permission (consent) for the treatment.

We advise that you do not get pregnant or make someone pregnant:

• during your treatment
• for at least 6 months after finishing treatment

If there is a risk that having sex could result in a pregnancy, it is important to use reliable protection (contraception) throughout this period. Your doctor talks to you about this in more detail.

Other treatment options

Several treatments may help people who have neuroendocrine tumours. You may have these treatments one after another or together. They include:

Painkillers

We may prescribe painkillers to help you manage pain symptoms.

Somatostatin analogues

These are man-made versions of the hormone somatostatin and include the medicines octreotide, lanreotide and pasireotide. We give you injections of medicine to:

• ease specific symptoms
• help make your condition stable

Interferon alpha

This is a biological therapy, which uses the body's immune system to kill cancer cells. We give you the medicine as an injection to help prevent tumour growth and symptoms.

Surgery

If it is possible to reach the tumour, surgery can either:

• remove the tumour completely
• reduce the size of the tumour and improve your symptoms

Chemotherapy

Chemotherapy uses medicines to kill cancer cells. The aims are to:

• reduce the size of the tumour
• improve your symptoms

We usually give you chemotherapy as a drip into a vein in your hand or arm. Most neuroendocrine tumours are not very sensitive to chemotherapy treatment.

Targeted therapies

Targeted therapies are anti-cancer medicines, such as sunitinib or everolimus. They interfere with how cancer cells grow and divide. You take the medicine by mouth to reduce the growth and spread of the tumour.

Embolisation

This is a treatment that reduces the blood flow to the tumour to control symptoms. It can sometimes be combined with chemotherapy or radiotherapy to prevent the growth of tumour cells.

Radiofrequency ablation

This is a procedure done under general anaesthetic, which is a medicine to make you sleep throughout the treatment. We use a low electrical current, which delivers heat to remove liver tumours.

Other targeted radionuclide therapies

Apart from lutetium therapy, there are other targeted radionuclide therapies. They include a treatment called 131l-MIBG, which uses a radioactive type of iodine to kill tumour cells.

Not having treatment

After talking to your health team about all your treatment options, you may decide that you prefer not to have any treatment. In some cases, your health team may feel that treatments will not help you.

If you are not having treatment, your health team can refer you for palliative care near your home. This supports you and helps to ease your symptoms but does not cure you.

You can also have palliative care together with some of the treatments listed in this section.

Sharing your information between hospitals

Guy's and St Thomas' Hospitals work closely with a network of other hospitals as a joint European Centre of Excellence for the management of neuroendocrine tumours. We work together to:

• give our patients the best possible care
• share best practice

We may share information about you between the hospitals. This is to make sure that everyone you meet always has the most up-to-date information about your health.

The information is:

• managed securely according to strict NHS rules
• only accessible to staff who are directly involved in your care