Fatigue After Lutetium-177 (LU-177) Infusion
Fatigue typically begins within hours to days after LU-177 infusion and can last up to 24 hours, with symptoms managed effectively with non-steroidal anti-inflammatory drugs (NSAIDs). 1
Timeline of Fatigue Onset
Fatigue is a common side effect of Lutetium-177 therapy and typically follows this pattern:
- Immediate to short-term (hours to days): Most patients experience fatigue shortly after infusion
- Duration: Typically lasts up to 24 hours, similar to other infusion-related reactions 1
- Resolution: Usually self-limiting and resolves spontaneously
Clinical Evidence
The VISION trial, which established LU-177-PSMA-617 as an effective treatment for metastatic castration-resistant prostate cancer, reported fatigue as one of the significant adverse events 1, 2. The National Comprehensive Cancer Network (NCCN) guidelines specifically note that fatigue is among the common adverse events with LU-177 therapy 1.
Management Recommendations
For fatigue occurring after LU-177 infusion:
- First-line treatment: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for managing flu-like symptoms including fatigue 1
- Hydration: Ensure adequate hydration (at least 500 ml of water) before and after treatment 3
- Monitoring: If fatigue persists beyond a few days, medical evaluation is recommended as it may indicate other issues such as hypophosphatemia 1
Important Considerations
- Severity assessment: Grade 3 or higher fatigue was significantly more common in patients receiving LU-177-PSMA-617 compared to control groups in clinical trials 1, 2
- Contributing factors: Monitor for potential contributing factors such as:
Pitfalls and Caveats
- Delayed reactions: While most fatigue occurs shortly after infusion, be alert for delayed reactions that may occur several hours to days after treatment 1
- Persistent symptoms: Fatigue lasting more than a few days requires evaluation as it may indicate other pathologies 1
- Quality of life impact: Despite higher incidence of adverse events including fatigue, studies show LU-177 therapy does not adversely affect overall quality of life 2
Follow-up Recommendations
- Complete blood count monitoring every 2-4 weeks after treatment 3
- Renal and liver function tests before subsequent treatment cycles 3
- Assessment for potential thyroid dysfunction, which can manifest as fatigue 4
If fatigue is severe or persists beyond the expected timeframe of 24 hours, prompt medical evaluation is recommended to rule out other causes or complications of therapy.