Will a Lutetium-177 (Lu-177) infusion make me feel unwell for several days?

Lutetium-177 Infusion Side Effects

Lutetium-177 infusions may cause mild side effects for several days, primarily including nausea, vomiting, and fatigue, but severe reactions are rare and most patients tolerate the treatment well.

Common Side Effects and Their Duration

Lutetium-177 (Lu-177) therapy is a type of peptide receptor radionuclide therapy (PRRNT) that is primarily used for treating neuroendocrine tumors and other somatostatin receptor-positive tumors. Based on clinical guidelines, patients may experience the following side effects:

• Immediate reactions (during or shortly after infusion):

  • Nausea and vomiting (most common)
  • Rarely, allergic reactions (mild in most cases, severe anaphylactoid reactions occur in approximately 0.04% of cases) 1
  • Blood pressure and pulse changes (requiring monitoring before and after therapy) 2

• Short-term effects (days following treatment):

  • Fatigue (common) 2
  • Possible "tumor flare reaction" causing temporary worsening of symptoms related to bone or soft tissue metastases 3
  • Potential weight gain (as reported in some cases) 4

• Delayed effects (1-2 weeks after treatment):

  • Lymphopenia (decreased lymphocyte count) may occur around day 15, affecting 9-30% of patients 2
  • Hematologic parameters typically decrease during treatment but recover between treatment courses 2

Managing Side Effects

To minimize discomfort and side effects:

1. Before treatment:

   • Ensure adequate hydration (at least 500 ml of water) 12 hours before treatment 2
   • Avoid large meals on treatment day due to possible nausea from amino acid infusion 2
   • Anti-emetics may be administered before amino acid infusion to prevent nausea 2

2. During treatment:

   • A physician must remain nearby during administration 1
   • Vital signs (blood pressure and pulse) should be monitored, especially in symptomatic patients 2

3. For tumor flare reactions:

   • Short courses of corticosteroids can mitigate symptoms if they occur 3

Important Considerations

Safety Profile

The overall safety profile of Lu-177 therapy is favorable:

• Clinically significant hematotoxicity is rare 2
• Extended therapy with Lu-177 has not been associated with increased grade 3-4 toxicity 2
• Most patients tolerate the treatment well with manageable side effects

Special Cases

Be aware of rare but reported adverse effects:

• Thyroid dysfunction has been reported (monitoring thyroid function tests may be considered) 4
• Very rare cases of hemolytic anemia have been documented 5

Post-Treatment Precautions

After treatment, patients should:

• Observe rigorous hygiene for 1 week following treatment (double toilet flush, thorough handwashing) 2
• Limit close contact (<3 feet) with household contacts for 2 days or with children and pregnant women for 7 days 2
• Sleep in a separate bedroom from household contacts for 3 days, from children for 7 days, or from pregnant women for 15 days 2

Conclusion

While you may experience some side effects like fatigue, nausea, or vomiting for several days after your Lu-177 infusion, these are typically mild and manageable. Severe reactions are rare, and most patients tolerate the treatment well. Your healthcare team will monitor you closely and can provide supportive care to manage any symptoms that develop.