Peptide Receptor Radioparticle Therapy (PRRT)

If you or a loved one has been diagnosed with a neuroendocrine tumor (NET), also known as a carcinoid, it is vitally important to be treated by highly skilled and experienced cancer specialists who use the most advanced and effective therapies.

At the Virginia Mason Cancer Institute, our specialists have extensive experience and training to determine the best treatment plan for each patient's distinctive tumor(s).

NET/Carcinoid Treatment Options

There are many different treatments for NETs. Treatment plans are customized for each individual’s personal situation, and may include:

  • Surgery
  • Liver Directed Therapy — includes chemoembolization, Y-90 radioembolization, radiofrequency ablation, liver radiation
  • Somatostatin Analogues — such as Octreotide and Lanreotide to slow down the production of hormones
  • Small Molecule Therapy
  • Chemotherapy
  • Peptide Receptor Radioparticle Therapy (PRRT)
  • Clinical Trial Therapy

Precision Diagnostics

NETs are rare but every NET is different. At Virginia Mason, we use Gallium-68 Dotatate (NETSPOTÒ®) scans and other diagnostic procedures to fully understand a patient's condition.

Peptide Receptor Radioparticle Therapy (PRRT) at the Virginia Mason Cancer Institute

Virginia Mason has been treating patients with neuroendocrine tumors since 2017 with Peptide Receptor Radioparticle Therapy (PRRT), a ground-breaking new technique which uses a radioactive protein to find the tumor, bind to it, and destroy the cancer cells while sparing the cells around it.

When should PRRT be used?

Before recommending PRRT, we confirm a patient's NET grade. If necessary, we will review the results of any previous biopsies and, in some cases, a new biopsy from the tumor may be needed.

NETs/carcinoid tumors are categorized into three grades:

  • Grade 1: Slow growth rate
  • Grade 2: Moderate growth rate
  • Grade 3: Rapid growth rate, aggressive (also called NEC: neuroendocrine carcinoma)

Grades 1 and 2 tumors are the ones mainly treated with PRRT.

PRRT Treatment Details

PRRT treatment usually consists of four treatments with intervals of 8-10 weeks. In some cases, the treatment might need to be delayed or terminated.

The outpatient treatments take place on Wednesdays, Thursdays and Fridays in a dedicated treatment room at Virginia Mason Medical Center in the Hematology and Oncology Department.

Patients are given a firm treatment date approximately two weeks before the PRRT treatment. Once this is agreed upon, it cannot be changed except for a medical reason. A patient's last long-acting Octreotide (Sandostatin LAR®) or Lanreotide (Somatuline DEPOT®) injection should be three or more weeks before their PRRT treatment.

Practical Matters During Treatment

Patients:

  • May consume their own food and drink.
  • Should bring their own medications (and take them as they do at home.)
  • Can wear their own clothes during and after treatment.
  • May bring their own books, magazines, communication devices or other entertainment.
  • May bring a friend or family member into the treatment room except during the time that they are receiving the IV radiation.

Day of Treatment

Patients arrive at 8 a.m. (10 a.m. on Fridays) and have two intravenous lines placed in their arms. The treatment is started with a solution containing proteins to protect the kidneys.

The actual PRRT with Lutetium-177 DOTATE (Lutathera®) starts 30 minutes later and lasts about 30 minutes. The protein solution is then continued for another three hours. The intravenous access is then removed. Some patients have mild nausea, which is treated with intravenous nausea medication.

Day of Treatment

Patients arrive at 8 a.m. (10 a.m. on Fridays) and have two intravenous lines placed in their arms. The treatment is started with a solution containing proteins to protect the kidneys.

Discharge and Safety

Patients arriving at 8 a.m. should be ready to go home by the early afternoon. They will be given education and information to ensure that they do not expose others to the radiation that is still in the body and leaves mainly through the urine. A travel declaration will be provided for international travel.

Risks and Side Effects

Possible side effects during or after the treatment are:

  • Fatigue
  • Nausea, mild and occurs in about 10 percent of treatments
  • Mild loss of hair, no baldness. After treatment, the hair grows again.
  • Hormonal crisis (occurring in one percent of patients.) This is a temporary risk primarily with tumors that produce a large amount of hormones. There can be a temporary worsening of symptoms. We provide supportive measures to prevent this from happening.
  • Reversible decrease in blood cells, including red blood cells, platelets and white blood cells. These levels are checked before each treatment and if they are too low, the treatment is delayed or decreased or both.

Long term risks are:

  • Serious deterioration of the kidney function (occurring in less than one percent of the patients)
  • Serious deterioration of the bone marrow function (occurring in two percent of the patients)

Results of PRRT Treatment

There are strong indications that patients who are treated with PRRT lutetium-177 DOTATE live longer on average and have a better quality of life. The two most important studies that have shown this are published: