Side Effects of Lutetium-177 (LU-177) Infusion
Most side effects from Lutetium-177 infusion typically occur within the first few days after treatment, with some immediate reactions possible during infusion and others developing over the following weeks.
Timing of Side Effects
Immediate/During Infusion
- Infusion reactions may occur during administration or shortly after, though they are relatively uncommon with LU-177 compared to other systemic anticancer therapies 1
- Symptoms may include flushing, nausea, vomiting, and blood pressure changes 1, 2
- A physician must remain nearby during administration to monitor for these immediate reactions 1
First 48 Hours
- Nausea and vomiting are common in the first 1-2 days, primarily due to the amino acid co-infusion rather than the LU-177 itself 2, 3
- Patients should observe rigorous hygiene during the first 2 days after treatment due to high levels of radioactivity in urine 1, 2
First Week
- Fatigue commonly occurs within the first week and may persist 2, 4
- Dry mouth symptoms may begin within the first week 4
- Radiation protection precautions are most important during the first week 2
2-4 Weeks
- Hematological side effects typically appear 2-4 weeks after infusion 5, 6
- Blood count nadirs (lowest points) for neutrophils and platelets typically occur 4-6 weeks post-treatment 5
- Lymphopenia (decreased lymphocyte count) may be observed around day 15 3
Common Side Effects by System
Gastrointestinal
- Nausea and vomiting (20-30% of patients) 7, 4
- Decreased appetite (20-30% of patients) 4
- Constipation (20% of patients) 4
- Dry mouth (20-30% of patients) 4
Hematological
- Anemia (20-30% of patients) 7, 4
- Thrombocytopenia (2-10% of patients, grade 3-4 in approximately 2%) 7, 5
- Neutropenia (1-10% of patients, grade 3-4 in approximately 1%) 7, 5
- Lymphopenia (9-30% of patients) 1, 3
General
- Fatigue (most common side effect, affecting >20% of patients) 7, 4
- Electrolyte disturbances (decreased calcium, sodium) 4
Monitoring and Follow-up
- Complete blood count should be performed every 2-4 weeks after treatment 1
- Renal and liver function tests should be performed before subsequent cycles 1
- Long-term follow-up includes blood tests every 8-12 weeks for the first 12 months 1
- Imaging is typically performed after each cycle to assess treatment response 2
Precautions and Management
- Adequate hydration is essential before and after treatment (at least 1L of water per day) 2
- Anti-emetics may be administered prophylactically to manage nausea 2
- Vital signs should be monitored before and after infusion in symptomatic patients 1
- Patients should limit close contact with others, particularly children and pregnant women, for several days after treatment 2
Remember that individual responses to LU-177 therapy vary, and your healthcare team will monitor you closely throughout the treatment process. Report any concerning symptoms promptly to your healthcare provider.