What is Peptide Receptor Radionuclide Therapy (PRRT)?

What is PRRT?

Peptide Receptor Radionuclide Therapy (PRRT) using Lutetium 177  (Lu-177) dotatate treats neuroendocrine tumors (NETs) by converting a cancer cell’s unique characteristics into a welcome mat for a “Trojan Horse” packed with cancer-killing radiation. This novel approach was approved for use in the United States on January 26, 2018.

How does PRRT work?

Some NET cells, unlike healthy cells, have proteins on their cell surface called receptors, that can bind to hormones, such as somatostatin. PRRT with Lu-177  targets these receptors with radiopeptides.

  • A peptide (a group of amino acids) is created that can bind to the receptors on a tumor cell’s surface.
  • The peptide is then paired with a radionucleotide (a radioactive atom) using a chelator (bonding agent).
  • The combination creates a radiopeptide.
  • The radiopeptide is injected into a patient’s bloodstream.
  • The radiopeptide finds and binds to the NET cancer cell’s somastatin receptor.

The radiopeptide emits radiation that kills the NET cancer cell.

Benefits of PRRT

Patients undergo multiple sessions of PRRT with Lu 177 a few months apart. Studies have shown PRRT can:

  • Increase survival
  • Improve the quality of life
  • Relieve symptoms
  • Decrease tumor size

PRRT Side Effects

PRRT with Lu 177  is generally well tolerated. Common side-effects of Lu-177 therapy are nausea, vomiting, and abdominal pain. Other less common side-effects are bone, liver and kidney toxicity, and mild hair loss.

Research on PRRT

Two radiopeptides are commonly used in PRRT: yttrium 90 (90Y) and lutetium 177 (Lu 177). Results of the NETTER-1 study, a large phase III randomized clinical trial published earlier this year, showed lutetium Lu 177 dotatate improved progression-free survival a median of 33 months when compared to high-dose OctreotideLAR in patients with advanced midgut NETs.

The Neuroendocrine Tumor Research Foundation (NETRF) uses charitable donations to fund promising treatments for NETs, like PRRT. Recently, NETRF, in collaboration with the Educational Research Fund for Nuclear Medicine and Molecular Imaging, funded an early phase clinical research of PRRT. Tom Hope, M.D, University of California, San Francisco is conducting a pilot study to evaluate the safety of Yttrium-90 DOTA-TOC Intra-arterial (IA) Peptide Receptor Radionuclide Therapy (PRRT) for Neuroendocrine Tumor. Dr. Hope’s study delivers PRRT through the arteries (intra-arterial) as opposed to the veins (intravenous or IV) to concentrate dosages in tumors and limit toxicity.

Watch Dr. Hope present an overview of PRRT at a regional NETRF patient education conference

PRRT in Europe

Physicians in the Netherlands, Germany, and other countries have used PRRT for years. On September 29, 2017, the European Commission approved the marketing of lutetium (177Lu) oxodotreotide for midgut NETs in all 28 European Union member states, as well as Iceland, Norway, and Liechtenstein.

PRRT in the United States

US Food and Drug Administration (FDA) approved lutetium Lu 177 dotatate for the treatment of somatostatin receptor positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs), including foregut, midgut, and hindgut neuroendocrine tumors in adults.

Lutathera is manufactured by Advanced Accelerator Applications (AAA), a Novartis company.

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Brint

Prior to FDA approval, will any of the expanded access institutions allow a patient with stage IV pancreatic neuroendocrine tumor to receive PRRT treatment?

Sharon

Will this treatment PRRT be available in Canada? Is it going to be available to someone with compromised kidneys?
My husband started Cap-tem yesterday for Neuroendocine Pancreatic Cancer that has metastasized to the liver, stage 4. He has had 5 years with good results. Now therapy as quit working for him & in a matter of a month, his tumors have doubled in size.

James

Sharon,

Your husband recently started Captem because prior treatments stopped working? If so, what were the prior treatments?

I’ve been researching PRRT quite a bit lately, and am also in Canada. It’s not a form of standard treatment yet, but they are looking into it. There are four trials going on right now concerning NETs, two in Onatario, and one each in Quebec and Alberta. Links below.

Ontario
https://clinicaltrials.gov/ct2/show/NCT02236910
https://clinicaltrials.gov/ct2/show/NCT02743741

Quebec
https://clinicaltrials.gov/ct2/show/NCT02754297

Alberta
https://clinicaltrials.gov/ct2/show/NCT01876771

Linda

Prrt approved in us in 1/26/17 for nets . Available at several major cancer hospitals as well as Europe where it has been used for about 20 years.

Where in the US is it available?
Thank you

Kate

My mom is currently receiving this at OSU Columbus Ohio USA, she’s one of the first people to receive it in the USA.

Tricia

It has now become available at Swedish Hospital in Seattle, WA. My daughter will begin the process for having PRRT in January. She has high grade pancreatic NET that has metastasized to her liver so is stage 4.

sam

Rocky Mountain Cancer Center and UC Health Anschutz in the Denver metro area

Leslie

I don’t see why not. My BIL has stage 4 PNET that spread to his liver and will be starting PRRT in 2 months at UCLA.

Laura K

How are you doing? Is the treatment working? I’m am starting down the path you are walking.

M J

Thank you so much for this up-to-date summary. I received PRRT at Stanford as part of the FDA Early Access Program, and I look forward to learning the results of Dr. Hope’s research at UCSF since I may be a good candidate for that treatment when the time comes. “The right treatment at the right time” is theme of our story…and we need all the information you can provide.

John

I have been a PNETS patient at Stanford since early 2017. Large mass on head of pancreas plus mets on liver. Inoperative due to heart issues. Cap-Tem 14 months, now Octreotide/Afinitor. Hoping for PRRT trial. How did you get approval for PRRT at Stanford? When I inquired they said billing (i assume insurance issues) was still a problem.
Thanks for any input.

Ralph

Given the regressive nature that seems to permeate Washington, I am not sure the politicians will move-this-through the process anytime soon. I HOPE I AM WRONG, THOUGH!

Rich

All well and good. EXCEPT when after treatment is over I now have MDS!!!!! Tumors did shrink somewhat so procedure is considered a success?

David

What is MDS?

Ann

Myelodysplastic Syndrome: bone marrow failure basically.

Gerald

still waiting dec.24 2018
What are you waiting for
I’m dieing here

Can we share our symptoms?

Raul

Have any of you tried to go the clinic in Rotterdam in the Netherlands? I am trying to convince my mom to go there.
Rich – you developed MDS? where were you treated? would you mind sharing whether you have a Pancreatic NET or a Gut NET?
My mother has a pancreatic NET with Liver Metastasis. She is being treated with Octreotide now.

Leland

I have Pancreatic Neuroendocrine cancer stage IV, pancreas, spleen, liver, and on surface of stomach. Diagnosed Feb ‘16; on octreotide & afinitor through Aug ‘17, when scan indicated tumors enlarging.
Became candidate for PRRT stage III clinical trial at Memorial Sloan Kettering, Dr Eileen O’Reilly. Started trial Dec 14, ‘17; 2nd trial treatment Feb 8, ‘18; awaiting 3rd treatment April 5. Last scheduled treatment is May 31, then rescan and reevaluate. Just waiting to finish and know the results. There is much waiting and anticipation with the PNET and treatment. Enjoying every day, family and friends.

Lynne

Leland, I’m a stage 4 neuroendocrine cancer patient and have been on Sandistatin shots for 8 years to stabilize tumor growth… Ihave been a patient (2 surgeries) at Mayo Clinic and they now have started prrt therapy and it has been recommended for me, but there is a waiting list to get the treatments. I have recently seen an oncologist at KU medical center and they are awaiting their final trial before beginning treatments, hopefully in May. They think I should go directly to the prrt therapy rather than wait for 3 months and take Affini-tor, as Mayo has prescribed…… Read more »

Hope

I also did the trial at MSKCC but unfortunately it did not work for me. After only a few months the tumors in my liver were growing again.
I was told insurance might be an issue if I waited until it was approved as opposed to being part of the trials.

Janie

Does. Medicare or blue cross pay for prrt

Mollie

I am in the process of being approved for PRRT at Mayo Rochester. I do not know much about this new procedure. I am looking for anyone who has had the procedure and how it is done, any side effects, or good websites. Thank you, your helped is much appreciated.

Dave

Last week I did my first treatment of PRRT at Excel Diagnostics in Houston. They have been doing treatments there for about eight years under a controlled study and were very professional and knowledgeable. I have three more to go. I have a fully involved pancreas, portal vein blockage and beginning involvement in liver. Three days of tests and one day of treatments. Tolerating it well, but some nausea and stomach upset three days after treatment. Beginning to feel pretty good now. They got me in within two weeks of contacting them. They have a website. Logistics are iffy, probably… Read more »

Bob

I am being scheduled for PRRT don’t know how soon yet. Has anyone that had the treatment had any issues with bone marrow, blood and platelet counts?
Any success stories out there or it too new?
Thank you

Denny

Hope to start this treatment soon..
Comments help..thank you

Dave

I just had my first PRRT Treatment Thursday the 8th of November at SCCA. All post scans completed and just can’t wait until the next round. I have been on Sando for years and had been getting two injections every two weeks. Was diagnosed in July 2008, two debulking surgeries and dealing with extreme syndromes everyday. Was so excited to get approval for this dream.

Scout

PRRT seems like a blessing! I was on monthly Sandostatin shots and had surgery in June, 2018 which included debulking of liver. Had PRRT treatments in August and October 2018. Dec and Feb PRRT treatments are scheduled. I have had substantial decrease in pain and symptoms. I know that future scan will show how successful the treatment is….my question is, “What is considered a successful PRRT treatment outcome? I had 3 rogue metasis, one each in 2 ribs, 1 in my spine. Can the treatments eradicate these?

Slly

I just had my first Lutathera treatment at research medical hospital in Kansas City today. Way too soon to know what will happen but one of the nicest things was being able to ask questions of experts both doctors and nurses about my disease (pancreatic net as part of my men 1 syndrome. I also had a net in my lung, both independent of each other. Im from a rural area and most doctors don’t know what to do with me. I had to travel from the other end of the state but worth it . Wouldn’t it be nice… Read more »

Sergio

Can anybody that finished the PRRT series comment on results?

Mom

My daughter has a net in her pancreas which has metastasized to 70% liver tumors. Any recommendations for Mercy Medical, Johns Hopkins in Baltimore (we live here) or other hospital specializing in NET treatment?

Sandy D

My husband has P-NET with mets to the liver (fully involved) and bone and then about an year ago it was found in the lymph nodes in chest cavity/trachea area and yesterday’s PETSCAN showed the lymph nodes are getting larger and more/liver is growing and a new spot of the pelvic bone. He’s been stable for 5 years next month on Capectabine/Temozolomide (CAPTEM) the entire time. Yesterday, the dr recommended starting the LU-177 treatment. My concern is what happens after the 6 months, what chemo then? He said he found a study showing staying on the CAPTEM while doing the… Read more »

What is Peptide Receptor Radionuclide Therapy (PRRT)?