177-Lutetium-Octreotate

Transcription

1 177-Lutetium-Octreotate Therapy Peptide Receptor Radionuclide Therapy (PRRT) for Octreotide Avid Tumours What is this cancer? You have been diagnosed with a Neuroendocrine Tumour. This tumour developed from the hormone-producing cells in your body that began to divide and multiply without control and eventually formed a growth of abnormal tissue called a tumour. JUST DIAGNOSED Neuroendocrine tumours can be functional meaning they produce EXCESS hormones or non-functional meaning they DO NOT produce excess hormones. It is the excess hormone released into the bloodstream that causes individuals to feel unwell. How can this cancer be treated? Most Neuroendocrine Tumours have special receptors that attach to a naturally occurring hormone that we all produce called somatostatin. Octreotide is able to attach to these receptors. 177-Lutetium is a targeted therapy, meaning it attacks the tumour directly. Will 177-Lutetium-Octreotate cure my cancer? This treatment will not cure the cancer. It can be very effective in decreasing tumour size or it may stop its growth. It does not seem to matter if the tumour deposits shrink or stay the same size, there is benefit in both cases.

2 Precautions to be taken 177-Lutetium is radioactive and is not given if you are pregnant. If there any concerns about pregnancy, a pregnancy test will be done. Reliable birth control should be used until treatment has finished and for at least 6 months afterward. Men are advised not to father a child for the same period. If you are breast-feeding, you must tell your doctor. Breast-feeding must stop before you have this treatment. What should I do if my Sandostatin LAR is due near my treatment date? We do not want your Sandostatin LAR to be given 48 hours prior to your Lutetium therapy. It can be given 3 days after the treatment. Your visiting nurse will require an order from the doctor to change the day. We can help you rearrange the date if necessary. Please inform your nurse of any conflict. What needs to be done before my treatment? There are three scans that need to be done before you have your first treatment. You will require a CT scan or MRI, renal scan, and an In111 Octreotide scan. Only the neuroendocrine tumours where In111 Octreotide attaches to the tumour will be considered for this therapy. A renal scan is necessary because the excess 177-Lutetium passes through the kidney and is excreted in the urine. A CT or MRI is required as a baseline to determine the efficacy of the therapy. You must STOP all herbal preparations, vitamin C and E one week prior to the treatment. These are not to be resumed until after all therapy is completed. These agents can potentially inhibit the effectiveness of the treatment. Who does the therapy and where is it given? The 177-Lutetium-Octreotate therapy is administered by a Nuclear Medicine physician. The therapy days are Monday and Tuesday. 2

3 When treatment is scheduled on a Monday, you will be evaluated in the Cancer Centre on Thursday. On the Sunday, between 2:00 pm and 3:00 pm, you must report to the admitting department where you will be directed to C-7, the oncology floor. On Tuesday morning, when the radiation reading in your body is at an acceptable level, you will be discharged to the Nuclear Medicine Department for the post therapy scan. You may go home after this scan is complete. When treatment is scheduled on a Tuesday, you will be evaluated in the Nuclear Medicine Department. Your appointment will be 8:15 am. Bloodwork will be done and you will be evaluated by our physicians. The next step is to report to admitting where they will advise you when the bed will be available for your treatment. The 177-Lutetium will be administered later that afternoon. On Wednesday morning, when the radiation reading in your body is at an acceptable level, you will be discharged to the Nuclear Medicine Department for the post therapy scan. 177-Lutetium is administered in the hospital intravenously (IV) over minutes. In the future, we may be able to administer the 177-Lutetium as an outpatient in the Nuclear Medicine Department. Day of 177-Lutetium Therapy You must drink ml cups of fluid. This can be water, juice, milk, carbonated decaffeinated beverages, decaffeinated coffee or tea, Boost, Ensure, or Gatorade. An IV will be started about one hour before your therapy. You will receive a mixture of amino acids which helps flush the radioactivity from your kidneys and helps protect your kidneys. The 177-Lutetium will be administered IV after that hour and will take minutes. The amino acids will continue until the entire volume is completed, about 4-6 hours. The IV will continue for the next 8 hours to flush the kidneys of any excess radioactivity. Once the IV is discontinued you must drink ml cup of fluid every hour for the next 2 hours. The following morning you must drink cup of fluid each hour, for the next 3 hours. 3

4 After the 177-Lutetium has been administered, the door to your room will be closed and there will be minimal nursing care provided. You have a window, a bathroom, and can rent a TV or telephone. This entire process will take 8-10 hours. Visitors are restricted to a maximum of three 30 minute visits every 24 hours for the same visitor. They must stay 1-2 meters from your bed. No physical contact is permitted. How will I feel after the treatment? 177-Lutetium therapy is often referred to as targeted therapy because of the way it attaches to the receptors on the tumour. A very small amount of normal tissue is exposed to radiation so side effects are minimal. Some individuals will experience nausea and vomiting during or shortly after the actual administration of 177-Lutetium. This can easily be managed while you are in hospital and anti-nausea medication can be provided upon discharge. It has been reported that some individuals have a decreased appetite for 7-14 days post therapy. It is important you drink 8-10 cups of fluid daily if this occurs. There may be an increase or symptom of abdominal pressure, fullness for up to 7 days after the treatment is administered. Pain is commonly due to tumour lysis (breakdown, destruction of the cancer cells). If the pain has not returned to the level of pain you normally experience, you must call your health care team. Your weekly blood tests may also provide information as to the cause of pain (the liver test results may be elevated). It has been reported there may be some hair loss. This is usually mild and regrowth of hair occurs after finishing therapy. This is not like with some IV chemotherapy where there is significant hair loss. Discharge Day A staff member from Nuclear Medicine will come to your room to measure the radiation levels by 9:00 am. Your door will be opened and you will be discharged from the inpatient unit to the Nuclear Medicine department where a post therapy scan will be done. This scan will take at least 90 minutes. 4

5 A radiation safety instruction information sheet will be given to you by Nuclear Medicine. It is recommended for the first 48 hours after treatment you double flush the toilet after use, also practice good hand washing. You must avoid sexual intercourse and kissing for 48 hours. You must wait for 24 hours after treatment to be in close contact with infants and children. There are no restrictions with pregnant women. You will be given a Ministry of Health requisition for weekly blood tests. They are to be done at a private lab close to your home. The results are sent weekly to the Cancer Centre and reviewed. If there are concerns you will be notified by your doctor or nurse. Ensure that you receive a wallet size card that documents the type of radiation received and the dose. This information is required if you plan to cross the border into the United States. You will not be going back to the inpatient unit. Take all your belongings with you to Nuclear Medicine. Make arrangements to meet your ride at London Health Sciences Centre. After Discharge For the first 6 weeks after your treatment, it is recommended you tell any doctor, nurse or pharmacist you have been treated with 177-Lutetium- Octreotate. It is recommended you carry this information brochure and the radiation card with you at all times. This information will help answer questions you may be asked. We plan to administer three 177-Lutetium therapies. They will be administered every 8-10 weeks based on your blood work results. We will inform you of the tentative date for the next therapy the day of admission. Three to four months after the third therapy, a CT scan or MRI and a renal scan will be arranged to assess the efficacy of the therapy and your kidney function. You will be provided with a clinic appointment. It is at this appointment you will receive the results and the next step in your plan of care will be discussed. 5

6 Note 177-Lutetium-Octreotate does not have a license for use in Canada. It is only available through the Special Access Program with Health Canada. This means that the results of the rigorous tests with respect to the efficacy of 177- Lutetium, side effects, and which patients with neuroendocrine tumours are more likely to benefit, have not yet been completed. By law we must obtain your written consent to accept 177-Lutetium Octreotate therapy. A member of your health care team will discuss the risks, benefits and alternative treatments with you. If you have any questions about the treatment, do not hesitate to ask to speak with your physician. Recommended Lodging If you need to stay in London the night prior to your admission we recommend the Country Inn & Suites. They are located almost directly across from the B Entrance into the London Health Sciences Centre. You can walk from their parking lot to the hospital. There is a complimentary breakfast included. They also have special rates for individuals who require the services of London Health Sciences. As of September 2012, the rate per night for 2 people is $ Baseline Road East NS6741 (2011/11/09) Updated December