Is double vision a side effect of Lutetium-177 (LU-177) treatment?

Double Vision as a Side Effect of Lutetium-177 (LU-177) Treatment

Double vision (diplopia) is not listed as a common side effect of Lutetium-177 (LU-177) treatment in the available guidelines, though neurological symptoms including dizziness can occur in some patients receiving this therapy.

Overview of LU-177 and Its Side Effects

Lutetium-177 vipivotide tetraxetan (Lu-177-PSMA-617) is a radiopharmaceutical approved for treating prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) in patients previously treated with androgen receptor pathway inhibition and taxane-based chemotherapy 1.

Common Side Effects

• The most commonly reported adverse events with LU-177 therapy include:
  • Hematologic toxicities: anemia, thrombocytopenia, and lymphopenia 1
  • Fatigue 1
  • Nausea and vomiting (often related to amino acid co-infusion) 1
  • Dry mouth 2

Neurological Side Effects

Recent research has identified several neurological symptoms that can occur with LU-177-PSMA-617 treatment:

• The most common neurological symptoms (from a single-center experience) were:

  • Altered taste/dysgeusia (11.9% of patients) 3
  • Dizziness (6% of patients) 3
  • Paresthesia (3.2% of patients) 3
  • Headaches (2.7% of patients) 3

• More serious but rare neurological events included:

  • Ischemic stroke (1.08% of patients) 3
  • Extremity weakness (1.08% of patients) 3
  • Gait disturbances (0.05% of patients) 3

• Double vision (diplopia) was not specifically mentioned in the available literature on LU-177 side effects 1, 3

Clinical Implications and Management

• Patients receiving LU-177 therapy should be monitored for neurological symptoms, though severe neurological problems appear to be rare 3

• Most neurological symptoms do not require discontinuation of treatment 3

• For patients experiencing dizziness (which could potentially cause visual disturbances), appropriate evaluation and supportive care should be provided 3

• If a patient reports double vision during LU-177 treatment:

  • A thorough neurological examination should be performed to rule out other causes 1
  • Consider the possibility of cranial nerve involvement if the patient has metastatic disease 1
  • Evaluate for potential central nervous system metastases 3

Conclusion

While specific reports of double vision as a direct side effect of LU-177 therapy are not documented in the current guidelines and research, patients should be monitored for various neurological symptoms. The absence of diplopia in the reported side effect profile suggests it is not a common adverse event, but individual patient experiences may vary 3.