Objectives: Since the approval of Lutetium-177 Dotatate (Lutathera) by the FDA in January 2018 for NETs, good response to neuroendocrine tumor therapy has been widely reported by NM facilities offering such therapy. The purpose of this study is to evaluate and provide education on the logistics surrounding Lutathera therapy, with regards to patient preparation, radiopharmaceutical administration, and radiation safety issues.

Methods: The patient preparation and protocols that are already set in place by hospitals for Lutathera therapy were reviewed. Nuclear Medicine physicians and technologists that have been working with Lu-177 Dotatate therapy were interviewed.

Results: Given the potential of renal toxicity, standard of care protocol for the delivery of Lutathera includes Amino Acid pretreatment to protect the kidneys and antiemetics to minimize nausea/vomiting caused by the Amino Acid. The whole therapy protocol, including the administering the non-radiopharmaceuticals, is a 4-6 hours process. Per the NRC, Lutetium-177 (T1/2 = 6.7 days) may contain Lu-177m as a contaminant with T1/2 of 161 days, which contributes approximately 0.02% of the total amount of Lu-177. Such a contaminant can not be decayed in storage under the rule 10 CFR 35.92, “Decay-in-storage,” as its half-life is >120 days.

Conclusion: Some medical facilities have opted against Lu-177 Dotatate use or the introduction of theranostics, as they do not have the means to deliver this service.

Aida Cesko would like to thank their faculty sponsor Dr. Crystal Botkin for their support of this project.