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The Challenges of Treating Paraganglioma Patients with 177Lu-DOTATATE PRRT: Catecholamine Crises, Tumor Lysis Syndrome and the Need for Modification of Treatment Protocols

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Abstract

Purpose

A high percentage of paragangliomas express somatostatin receptors that can be utilized for targeted radioisotope therapy. The aim of this study was to describe and discuss the challenges of treating these tumors with 177Lu-[DOTA0,Tyr3]octreotate (DOTATATE) radioisotope therapy using established protocols.

Methods and Results

Three paraganglioma patients were treated with 4–5 cycles of 177Lu-DOTATATE and were evaluated for side effects and response to therapy. Two of the three patients developed severe adverse reactions following their first 177Lu-DOTATATE treatment. One patient developed a catecholamine crisis and tumor lysis syndrome within hours of treatment, requiring intensive care unit (ICU) support, and another developed a catecholamine crisis 3 days after treatment, requiring hospitalization. The treatment protocols at our institution were subsequently modified by increasing the radioisotope infusion time from 15 to 30 min, as recommended in the literature, to 2–4 h and by reducing the administered dose of 177Lu-DOTATATE. Subsequent 177Lu-DOTATATE treatments utilizing the modified protocols were well tolerated, and response to therapy was achieved in all three patients, resulting in significantly improved quality of life.

Conclusion

177Lu-DOTATATE is an exciting new therapeutic option in the management of paragangliomas; however, current treatment protocols described in the literature may need to be modified by lengthening the infusion time and/or lowering the initial treatment dose to prevent or reduce the severity of adverse reactions.

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Conflict of Interest

William Makis, Karey McCann and Alexander JB McEwan declare that they have no conflicts of interest.

Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. The manuscript has been read and approved by all the authors, and the requirements for authorship have been met. Each author believes that the manuscript represents honest work.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Cross Cancer Institute, 11560 University Ave NW, Edmonton, Alberta, T6G 1Z2, Canada

    William Makis, Karey McCann & Alexander J. B. McEwan

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  1. William Makis
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  2. Karey McCann
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  3. Alexander J. B. McEwan
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Correspondence to William Makis.

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Makis, W., McCann, K. & McEwan, A.J.B. The Challenges of Treating Paraganglioma Patients with 177Lu-DOTATATE PRRT: Catecholamine Crises, Tumor Lysis Syndrome and the Need for Modification of Treatment Protocols. Nucl Med Mol Imaging 49, 223–230 (2015). https://doi.org/10.1007/s13139-015-0332-6

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  • DOI: https://doi.org/10.1007/s13139-015-0332-6

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