The Food and Drug Administration (FDA) has approved Lutathera (lutetium Lu 177 dotatate), a new iv radioactive drug, or radiopharmaceutical, to treat adults with somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Previously, there were few treatment options for this type of cancer if standard therapy did not control tumor growth.

GEP-NETs produce high levels of somatostatin, a hormone made in the pancreas that blocks the secretion of insulin and glucagon from other cells. Lutathera binds to somatostatin receptors present in GEP-NETs, allowing the drug to enter the tumor cells, forming free radicals to damage them. In clinical trials, patients who received Lutathera plus octreotide (a drug that mimics the action of somatostatin) had a significantly lower risk of death or tumor growth than patients who received octreotide alone.

Common adverse effects of Lutathera include lymphopenia, high levels of the enzymes gamma-glutamyltransferase (the most sensitive enzymatic indicator of liver disease) and alanine transaminase and aspartate transaminase (two other indicators of impaired liver function), vomiting, nausea, hyperglycemia, and hypokalemia. Serious adverse effects include myelosuppression, development of certain blood or bone marrow cancers (secondary myelodysplastic syndrome and leukemia), renal toxicity, hepatotoxicity, neuroendocrine hormonal crises (excessive release of hormones causing symptoms such as flushing, diarrhea, hypotension, or bronchoconstriction), and infertility. Lutathera also causes fetal harm.

Radiopharmaceuticals, including Lutathera, must be administered by physicians who have specific government-approved training in their safe use and handling. Nurses, however, play a key role in maintaining patient safety by ensuring that the drug is administered according to the label instructions. Important premedications and concomitant medications are required with Lutathera. Before receiving Lutathera, the patient must be given an antiemetic and an amino acid solution containing L-lysine and L-arginine. If premedication orders are missing, the nurse should consult with the prescriber. The antiemetic should be given 30 minutes before the iv amino acid solution, which should be started 30 minutes before administering Lutathera. The amino acid solution should continue during Lutathera administration and for three hours afterward. Patients should receive a total of four doses of Lutathera, one every eight weeks. Long-acting octreotide 30 mg im should be coadministered four to 24 hours after each dose of Lutathera. After the patient has received four doses of Lutathera, she or he should continue treatment with long-acting octreotide 30 mg im every four weeks for up to 18 months following treatment initiation. For complete instructions on the use of octreotide before and after Lutathera, see the Lutathera prescribing information: http://www.accessdata.fda.gov/drugsatfda_docs/label/2018/208700s000lbl.pdf.

Because Lutathera is a radiopharmaceutical, the patient and anyone with whom she or he comes in contact, including health care professionals, can be exposed to radiation. Normal safety precautions should be followed to minimize this exposure.

Nurses should encourage patients to increase their fluid intake and urinate frequently during and after Lutathera treatment to decrease the risk of renal toxicity. Daily nursing assessment of patients receiving the drug should include close monitoring of laboratory work for evidence of renal toxicity, hepatic toxicity, or myelosuppression. The Lutathera dose may need to be decreased or stopped if there is evidence of toxicity. Nurses should teach patients to use effective birth control while receiving Lutathera.