Lutetium-177 is a radioactive isotope that can be used in targeted radionuclide therapy for certain types of cancer, including neuroendocrine tumours. Neuroendocrine tumours are a less common type of cancer that can develop in various organs, such as the pancreas or gastrointestinal tract.
Targeted radionuclide therapy involves attaching a radioactive substance, like Lutetium-177, to a molecule that specifically targets and binds to cancer cells. This allows for precise delivery of radiation to cancer cells, minimising damage to surrounding healthy tissues. Peptide Receptor Radionuclide Therapy has been utilised for NETs in Australia for over 20 years. Lutetium-177 is a radioisotope utilised.
Clinical trials are crucial for evaluating the safety and efficacy of new treatments in Australia. These trials are conducted to gather data on the potential benefits and risks of a specific treatment regimen.
In Australia, Lutetium-177 trials have been undertaken for certain neuroendocrine tumours (NETs) for many years. This targeted internal radiotherapy, known as peptide receptor radionuclide therapy (PRRT), involves a straightforward process.
During treatment, participants can expect the following:
We will expand on this treatment process further down the page under the heading ‘The Lutetium-177 treatment process and what patients can expect’.
NeuroEndocrine Cancer Australia is here for the advocacy and support of all patients affected by NETs and their families. The content covered on this page is purely informational. For specific information related to your diagnosis, contact your healthcare team, or call our NET cancer nurse.
Clinical trials play a crucial and indispensable role in advancing and improving the treatment of neuroendocrine tumours (NETs), contributing significantly to the field of medical research. They are instrumental in enhancing our understanding of the disease and evaluating the safety and efficacy of new treatment approaches.
Several key aspects highlight the crucial role of clinical trials in advancing neuroendocrine tumour treatments:
Clinical trials serve as a platform for testing novel therapeutic interventions, allowing researchers to explore innovative approaches to treating neuroendocrine tumours. These trials often involve new drugs, treatment combinations, or targeted therapies that may represent potential breakthroughs in the management of NETs.
Through well-designed clinical trials, researchers can systematically assess the effectiveness of different treatment modalities. This includes technologies like targeted radionuclide therapy using substances like Lutetium-177.
Neuroendocrine tumours are a heterogeneous group, and individual responses to treatments can vary. Clinical trials contribute to the development of personalised medicine by identifying biomarkers and genetic factors that can help predict a patient’s response to specific therapies, minimising side effects.
Clinical trials contribute significantly to the scientific understanding of neuroendocrine tumours. Researchers gain insights into the underlying biology of NETs, disease progression, and factors influencing treatment outcomes. This knowledge informs subsequent trials and helps shape future therapeutic strategies.
Positive outcomes from clinical trials are crucial for obtaining regulatory approval for new drugs or treatments. The rigorous testing and evidence generated through these trials provide the basis for regulatory agencies to evaluate the safety and efficacy of new interventions before they are made widely available to patients.
In short, clinical trials are a cornerstone of medical research and a driving force behind advancements in neuroendocrine tumour treatments.
Explaining the criteria that determine whether a patient is eligible to participate in Lutetium-177 trials in Australia, including medical and demographic requirements.
The use of Lutetium-177 is part of a specialised and individualised treatment plan, and the administration process may vary based on the specific protocol prescribed by the treating healthcare team. Patients receiving Lutetium-177 therapy should discuss the procedure, potential side effects, and any concerns with their healthcare providers.
Here’s how the treatment process looks in a general sense.
Before undergoing Lutetium-177 treatment, patients typically undergo a comprehensive evaluation. This involves imaging studies, such as positron emission tomography (Gallium68 Dotatate PET Scan) scans and octreotide scans, to assess the extent and characteristics of neuroendocrine tumours.
The Lutetium-177 radiopharmaceutical is administered intravenously. The targeting molecule helps deliver the radioactive payload directly to the neuroendocrine tumour cells, allowing for more focused and localised treatment. The administration is done in a controlled environment with trained healthcare professionals overseeing the process.
An infusion will be given, after the injection of Lutetium-177, over 2 – 4 hours of Amino Acids to protect the kidneys from the radiation.
Once administered, Lutetium-177 emits beta radiation, which has a short range. This makes it effective in targeting and damaging nearby cancer cells while minimising damage to surrounding healthy tissues. The radiation emitted by Lutetium-177 works to destroy the neuroendocrine tumour cells and inhibit their ability to grow and divide.
After the Lutetium-177 treatment, patients are regularly monitored to assess treatment response and manage any potential side effects. Follow-up imaging studies and blood tests may be performed to evaluate the status of the neuroendocrine tumours and monitor overall health.
The treatment approach involving Capecitabine, Temozolomide, and Lutetium-177 is a combined strategy to tackle neuroendocrine tumours, particularly those in the gastroenteropancreatic region. The goal of this combination is to enhance the overall effectiveness of the treatment by attacking cancer cells from different angles.
As discussed, Lutetium-177 emits radiation, targeting cancer cells through a specific molecule that homes in on their somatostatin receptors. This radiotherapy damages the DNA of the tumour cells, hindering their growth.
Concurrently, Capecitabine, an oral chemotherapy drug, disrupts cancer cell division by converting it into 5-fluorouracil.
Additionally, Temozolomide, another oral chemotherapy drug, damages DNA through a distinct mechanism
The Lutetium-177 treatment process is often tailored to the individual patient’s condition. Treatment plans are developed based on the specific characteristics of the neuroendocrine tumours and the patient’s overall health.
Patients may be part of a multidisciplinary team, including oncologists, nuclear medicine specialists, and supportive care providers, to ensure comprehensive and well-coordinated care.
Regular follow-up appointments are essential to monitor the treatment’s effectiveness, manage any side effects, and address the patient’s overall well-being.
Patients are usually provided with information about the treatment, potential side effects, and self-care measures. Educational support helps empower patients to actively participate in their care.
With the benefits, there are risks to Lutetium-177 therapy that must be considered, much like any cancer treatment.
A 2020 study labelled Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours, is our best source of information when discussing Lutetium-177 clinical trials. The study was a retrospective review from 2002 to 2019 on 48 patients with Lu-dotatate PRRT for lung NETs. Data in the study included demographics, efficacy, and toxicity, evaluated by treating clinicians.
The results were as follows:
There are limitations when trialling NECs represent only 0.5% of overall cancer cases, and there are even small participant numbers due to the rarity of lung NETs.
The CONTROL NETs study focuses on the final results of the AGITG CONTROL NET Study, exploring the use of 177LuDOTATATE PRRT and CAPTEM for treating pNETs and mNETs.
Previous trials combining PRRT/CAPTEM showed promising results, prompting this investigation into the combined treatment’s efficacy in mNETs and pNETs.
The study is a non-comparative randomised Phase II trial with a 2:1 randomisation to PRRT/CAPTEM (experimental arm) and PRRT alone or CAPTEM alone (controls).
Treatment specifics include intravenous administration of 177Lu Octreotate and oral capecitabine/temozolomide in various cycles. The primary endpoint is progression-free survival (PFS), with secondary endpoints including objective tumour response rate, overall survival, and adverse events.
The results were as follows:
The study suggests that CAPTEM/PRRT is effective for pNETs, warranting further investigation in a phase III setting. Late hematologic toxicity was observed in mNET PRRT arms, but its incidence did not rise with the inclusion of CAPTEM. Extended follow-up supports the sustained efficacy of CAPTEM/PRRT.
Research in Lutetium-177 therapy for neuroendocrine tumours is an active and evolving field, with ongoing investigations aiming to improve the efficacy, safety, and applicability of this treatment. Here are some key areas of research and potential future directions:
Researchers are exploring combinations of Lutetium-177 therapy with other treatment modalities, such as targeted therapies or immunotherapies. The goal is to enhance the overall effectiveness of treatment by leveraging both treatments’ effects.
Studies are underway to determine the most effective dosage and treatment schedules for Lutetium-177 therapy. This includes investigating the ideal balance between delivering a therapeutic dose to cancer cells while minimising potential side effects.
Identifying predictive biomarkers is a crucial area of research. Researchers aim to identify specific biological markers that can help predict which patients are more likely to respond positively to Lutetium-177 therapy.
Long-term follow-up studies are crucial for understanding the durability of treatment responses and assessing the impact on patients’ quality of life. Research in this area helps refine treatment protocols and informs clinical decision-making.
It’s crucial for patients considering Lutetium-177 therapy to have detailed discussions with their healthcare team, including oncologists and nuclear medicine specialists. A thorough understanding of the potential benefits and risks, along with an assessment of individual health status, can help patients make informed decisions about whether Lutetium-177 therapy is an appropriate and suitable option for their neuroendocrine tumour treatment.
An introductory section providing an overview of Lutetium-177 and explaining its significance in the context of neuroendocrine tumour treatments. Providing a detailed overview of the Lutetium-177 trials specifically conducted in Australia, including their objectives, locations, and participants.
Discussing the crucial role of clinical trials in advancing and improving neuroendocrine tumour treatments, emphasising their importance in medical research.
Explaining the criteria that determine whether a patient is eligible to participate in Lutetium-177 trials in Australia, including medical and demographic requirements.
Describing the treatment process itself, including the administration of Lutetium-177, potential side effects, and what patients can expect during the treatment period.
Discussing the potential benefits and risks associated with Lutetium-177 therapy as a neuroendocrine treatment option, providing a balanced perspective.
Highlighting significant results and success stories that have emerged from Lutetium-177 trials in Australia, showcasing the positive impact of this treatment.
Exploring ongoing and future research directions related to Lutetium-177 therapy, including potential advancements and improvements in neuroendocrine treatments.
