Nuclear Medicine Targets Metastatic Neuroendocrine Tumors

Oct. 6, 2017

Emory Radiology’s Division of Nuclear Medicine and Molecular Imaging is teaming with colleagues in the School of Medicine’s Department of Medical Oncology and the Winship Cancer Institute to offer 177Lu-DOTA0-Tyr3-Octreotate or Lutetium177 DOTATATE (brand name Lutathera®) therapy for patients with metastatic neuroendocrine tumors (NET).

“This is a very promising therapy that shows the advantages that molecular radiotherapeutics can bring to the patient,” says Emory Radiology’s David M. Schuster, MD, associate professor and director of the Division of Nuclear Medicine and Molecular Imaging. “It’s exciting to bring yet another therapy from nuclear medicine to help patients who currently have no other treatment options.”

Lu 177 is part of a growing form of treatments called Peptide Receptor Radionuclide Therapy (PRRT). Such theranostics start with a ligand like DOTATATE that binds to receptors specific to certain tumors, in this case the somatostatin receptor 2. A novel imaging radiotracer was approved last year that combines DOTATATE with a radionuclide (Gallium-68) to locate and diagnose tumors using PET imaging.

Lu 177 also uses DOTATATE, but it is attached to a radionuclide that doesn’t just locate the tumor, it actually destroys tumor tissue with Beta particles when it binds to the tumor receptors.

While the radiopharmaceutical undergoes expedited review by the U.S. Food and Drug Administration (FDA), it is being offered under an approved Expanded Access Program at no more than a dozen medical centers in the U.S. Emory is the only medical center in Georgia to offer this promising therapy. Because it is offered under Expanded Access, there is no cost for the radiopharmaceutical itself.

The first patient began treatment at Emory in June; a second began treatment soon after and two additional patients are scheduled to begin the treatment protocol. Lu 177 is administered as 1 dose every 8 weeks for 4 cycles over 8 months. Patients also receive a special amino acid solution by infusion to protect the kidneys during treatment.

“As an NCI-designated comprehensive cancer center, Winship is ideally suited for us to provide this kind of care, which is truly a team effort,” says Dr. Schuster.

Key partners include Bassel El-Reyes, MD, professor and vice chair for clinical research in the School of Medicine’s Department of Hematology and Medical Oncology and, of course, the entire faculty and staff of the Division of Nuclear Medicine and Molecular Imaging. ■