Adverse Events in Targeted Radionuclide Therapy
Abstract
Purpose
Radiopharmaceutical therapy (RPT) plays an important role in the management of oncology patients, particularly those with thyroid cancer, prostate cancer, and neuroendocrine tumor. The use of radionuclide therapy has expanded rapidly in recent years, with the approval of new agents and indications. The number of ongoing RPT clinical trials suggests this trend is likely to continue in the future. Adequate knowledge of potential adverse events and their management is essential for nuclear medicine physicians to optimize outcomes in patients undergoing RPT. In this educational exhibit, we review and address adverse events that may occur in RPT, their clinical presentation, incidence, risk factors and management.
Methods
The RPT agents discussed herein include Lu-177 PSMA-617 (Pluvicto®), Lu-177DOTATATE (Lutathera®), Ra-223 dichloride (Xofigo®), and high-specific activity (HSA) I-131 MIBG (Azedra®) and I-131 MIBG. The prototypical RPT agent, I-131 NaI has already been covered extensively in the literature and therefore is only briefly discussed here, with a focus primarily on the newer Lu-177-based agents.
Results
While RPT with these agents is extremely safe and has proven to be very effective, recognition of potential acute adverse events is vital for physicians administering therapy to maintain safety of patients and optimize clinical outcomes. These adverse events are somewhat rare but should be recognized and managed appropriately. In many cases, there are potential strategies that can be employed to minimize the risk of such events, particularly in patients with identifiable risk factors. Adverse events reviewed here include radiopharmaceutical infiltration/extravasation, hematologic toxicity, refractory nausea, hormonal crisis, flare reaction, sialadenitis/xerostomia, renal toxicity and hepatic toxicity.
Conclusion
In summary, while RPT is generally well-tolerated and has proven to be very effective, adverse events do occur and should be recognized and managed appropriately. Identifying patients at risk and implementing preventative strategies or closer monitoring can improve patient safety and outcomes