PLUVICTO™ (lutetium Lu 177 vipivotide tetraxetan)*
PLUVICTO is radiopharmaceutical used to treat adults with advanced prostate cancer that is prostate-specific membrane antigen–positive (PSMA-positive), metastatic and castration-resistant (mCRPC). PSMA-positive prostate cancers can be detected by a special PET scan.
PLUVICTO is a treatment option for PSMA-positive mCRPC that (1) has spread to other parts of the body (metastatic), and (2) has already been treated with androgen receptor (AR) pathway inhibition and taxane-based chemotherapy.
Injected in up to 6 treatments at staggered intervals, the therapy allows radiation to be targeted to prostate cancer cells – with minimal effects on healthy cells – by binding to PSMA, the protein found on the surface of the cells.
The most common side effects of PLUVICTO include: tiredness, dry mouth, nausea, low red blood cell count, loss of appetite, changes in bowel movements (constipation or diarrhea), vomiting, low blood platelet count, urinary tract infection, weight loss, and abdominal pain.
*Due to an uptick in world-wide demand, the manufacturer of Pluvicto has announced a supply deficiency of the radiopharmaceutical. As a result, UF Health was required to halt scheduling new patients for treatment with Pluvicto. The supply shortage is expected to be resolved in late 2023.
Xofigo is a treatment option for some men with prostate cancer that has spread to the bone. Clinical trials have shown that Xofigo improved survival among men with castrate-resistant metastatic prostate cancer, or prostate cancer progressing on hormone therapy, and symptomatic bone metastases but no spread to other organs.
Xofigo, or radium-223, becomes integrated into newly formed bone, especially within bone metastases, and emits alpha particles, which can destroy nearby tumor cells within bone with radiation and spare nearby tissues. It is delivered as an intravenous (IV) injection on a monthly basis, usually for 6 months. Prior to each treatment, blood counts have to be carefully checked because of the risk that they may be lowered by Xofigo administration.
Other potential side effects from treatment include swelling in arms or legs, nausea, vomiting, and diarrhea, though if they occur, they are typically mild and short-lived. While there are not restrictions for contact with other people after treatment, a radiation safety officer will review recommended precautions for handling bodily fluids, such as urine, stool, semen, and blood, to reduce the risk of radiation exposure to others.
Lutathera/Lutetium Lu 177 dotatate
Lutathera is a medicine that can be used to treat advanced neuroendocrine tumors (NETs) affecting the gastrointestinal tract or pancreas, also known as gastroenteropancreatic (GEP) NETs. GEP NETs have special protein receptors on their surface, called somatostatin receptors. Lutathera is made up of a protein that binds to somatostatin receptors combined with a radionucleide, which emits radiation to damage these tumor cells. It is delivered by a slow intravenous (IV) infusion in combination with anti-nausea medication and an amino acid hydration solution over several hours every 8 weeks, typically 4 times.
Potential side effects include nausea, vomiting, and abdominal pain. Blood tests are performed on a regular basis because of the potential effects Lutathera has on blood counts and kidney and liver function. If you are currently taking a type of medicine known as a somatostatin analogue, such as octreotide, your doctor will discuss how to modify your treatment schedule so it does not interfere with Lutathera treatments.
Radioactive Iodine (RAI) Therapy
Because the thyroid gland naturally absorbs iodine, radioactive iodine can be used to treat thyroid cancer. The radiation is preferentially absorbed by thyroid cells and destroys any remaining normal and cancerous thyroid cells with minimal effect on other tissues.
The first step among patients considering this treatment is to meet a radiation oncologist for consultation. During that visit, we discuss the potential indications for RAI, in addition to the logistics of therapy, recommended dose, and risks and benefits of therapy. Once it is decided to proceed with RAI, the next step is to prepare for treatment with special medications and an iodine-deficient diet. We also review the recommended isolation parameters to decrease radiation exposure risk to others after treatment. On the day of delivery, RAI is typically administered by swallowing one or more pills, once.
Side effects, which are reviewed in detail at time of consultation, are typically mild, but may include nausea, swollen and/or tender salivary glands, dry mouth, and taste change. A total body scan is performed approximately one week after treatment. The long-term risk of infertility, decreasing blood counts, or causing another cancer is very low. Surveillance after treatment typically includes regular visits to monitor thyroid cancer blood work, which may be directed by an endocrinologist that specializes in the treatment of thyroid cancer.