How We Do It: A Multidisciplinary Approach to ¹⁷⁷Lu DOTATATE Peptide Receptor Radionuclide Therapy

Area of Science:

• Nuclear Medicine
• Oncology
• Radiochemistry

Background:

• Advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs) require effective therapeutic strategies.
• Lutetium 177 DOTA-0-Tyr3-Octreotate (¹⁷⁷Lu DOTATATE) peptide receptor radionuclide therapy (PRRT) has emerged as a significant treatment option.

Purpose of the Study:

• To present a comprehensive clinical practice workflow for ¹⁷⁷Lu DOTATATE PRRT.
• To provide a systematic checklist for patient selection and safe PRRT administration.
• To discuss adverse effects, follow-up imaging, and alternative treatment strategies.

Main Methods:

• Development and implementation of a multidisciplinary team-based workflow.
• Utilizing a systematic checklist for patient evaluation, including Gallium 68 DOTATATE PET/CT and Fluorine 18 fluorodeoxyglucose PET/CT for high-grade tumors.
• Review of adverse events, diagnostic imaging protocols, and case examples.

Main Results:

• A successful clinical workflow integrating nuclear medicine consultation, tumor boards, and pre-therapy preparations has been established.
• The systematic checklist aids in appropriate patient selection and identification of potential concerns for safe PRRT administration.
• Discussion of adverse effects, follow-up imaging, and challenging patient scenarios provides practical guidance.

Conclusions:

• The presented workflow ensures safe and effective administration of ¹⁷⁷Lu DOTATATE PRRT for advanced GEP-NETs.
• Multidisciplinary collaboration and systematic patient evaluation are crucial for successful PRRT outcomes.
• The review offers valuable insights into managing PRRT, including alternative theranostic approaches.