The Current Practice of Theranostics: Results of a National Survey and Lessons Learned

Theranostic programs are expanding rapidly, creating a growing need to understand how institutions implement [¹⁷⁷Lu]Lu-DOTATATE therapy and [¹⁷⁷Lu]Lu-PSMA-617 therapy in clinical practice. Methods: We distributed a 25-question online survey to U.S. health care institutions that administer ¹⁷⁷Lu therapies. The survey collected data on therapy administration, patient monitoring, imaging protocols, and radiation safety practices. Results: Thirty-five institutions responded. Practices varied widely in administration methods, vital sign monitoring, antiemetic use, and imaging protocols. Most sites infused [¹⁷⁷Lu]Lu-DOTATATE over an average of 30 min via pump or gravity method, whereas [¹⁷⁷Lu]Lu-PSMA-617 was more often administered by hand injection within 10 min. Vital signs were monitored at 91% of [¹⁷⁷Lu]Lu-DOTATATE therapy sites compared with 57% for [¹⁷⁷Lu]Lu-PSMA-617 therapy. Antiemetics were used at 97% of [¹⁷⁷Lu]Lu-DOTATATE sites versus 23% at [¹⁷⁷Lu]Lu-PSMA-617 sites. Posttherapy imaging was performed for 48% of [¹⁷⁷Lu]Lu-DOTATATE therapies and 57% of [¹⁷⁷Lu]Lu-PSMA-617 therapies, with substantial variation in timing and frequency. Conclusion: These results indicate significant variability in clinical theranostics practice in the United States and may result in meaningful differences in patient outcomes and satisfaction. The findings emphasize the necessity for consensus guidelines and standardization. This article also explores key lessons learned from real-world implementation, highlighting the evolving nature of theranostic programs as they expand in clinical practice.