What is the duration of a Lutetium-177 (Lu-177) infusion?

Lutetium-177 Infusion Duration

Lutetium-177 (Lu-177) is typically administered as an intravenous infusion over 10-30 minutes, with the exact duration depending on the infusion system used. 1

Administration Details

The European Journal of Nuclear Medicine and Molecular Imaging guidelines provide specific information about Lu-177 administration:

• Lu-177 is mixed with saline (final volume 10-100 ml) before administration 1
• Common administration methods include:
  • Gravity infusion
  • Infusion pump
  • Automated syringe pump injector 1

While traditional protocols often specify a 30-minute infusion time, recent research has demonstrated that faster infusion protocols may be safe and effective:

• A 2021 study found that a rapid infusion protocol with a maximum infusion time of less than 5 minutes was safe and feasible in clinical practice 2
• When using the traditional gravity method, approximately 50% of the activity is infused after 3.5 minutes, and 95% is infused within 15 minutes 2

Complete Treatment Protocol

The Lu-177 infusion is part of a more extensive treatment protocol that includes:

1. Pre-infusion preparation:

   • Patient hydration (at least 500 ml of water) 12 hours before treatment 1
   • Avoidance of large meals on treatment day 1

2. Amino acid co-infusion:

   • Typically consists of lysine (25g) and arginine (25g) in 2L of 0.9% NaCl 1
   • Started 30-60 minutes before Lu-177 administration 1
   • Continued for 4-6 hours at 250-500 ml/hour 1
   • Anti-emetics may be administered before amino acid infusion to prevent nausea 1
   • The amino acid infusion helps reduce nephrotoxic effects by decreasing tubular renal reabsorption of Lu-177 3

3. Lu-177 administration:

   • Standard dose: 5.55-7.4 GBq (150-200 mCi) per cycle 1
   • Administered over 10-30 minutes 1

Safety Considerations

During administration:

• A physician must be present during the infusion 1
• Vital signs (blood pressure and pulse) should be monitored, especially in symptomatic patients 1
• Radiation protection protocols must be followed according to local regulations 1
• Patients remain under surveillance for potential side effects such as nausea, vomiting, and rarely seizures 1

Potential Complications

• Extravasation (leakage of Lu-177 into surrounding tissue) is a potential complication that requires immediate attention 4
• Immediate reactions during or shortly after infusion may include:
  • Nausea and vomiting (most common) 1
  • Allergic reactions (rare, with severe anaphylactoid reactions occurring in approximately 0.04% of cases) 1

In summary, while Lu-177 is traditionally administered over 10-30 minutes, emerging evidence suggests that shorter infusion times may be safe and effective. The infusion is part of a comprehensive treatment protocol that includes pre-hydration and amino acid co-infusion to minimize side effects and protect kidney function.