Peptide Receptor Radionuclide Therapy (PRRT)
What is PRRT?
PRRT (Peptide Receptor Radionuclide Therapy) is a treatment used for neuroendocrine tumors (NETs). This treatment uses a medication called octreotide (a type of peptide or protein) and a small amount of a radioactive material (called a radionuclide). This is called a radiopeptide.
How does PRRT work?
Most NETs have receptors on their cells for a hormone called somatostatin. Octreotide is a manmade version of somatostatin, which is attracted to these receptors on the NETs. In PRRT, the octreotide has a radionuclide attached to it. This allows the octreotide to bring the radiation right to the tumor, and not to healthy tissues. This targeted therapy limits the radiation exposure to healthy tissue and often has fewer side effects than chemotherapy medications.
Lutetium 177 (Lu-177) is the most used radionuclide. Others that can be used are yttrium 90 (Y-90) and iodine-131 MIBG. Your provider will be able to talk to you about which radionuclide you will get.
What happens during PRRT?
This depends on the center doing your treatment and the radionuclide being used. PRRT is usually given in four treatments every two months over eight months. The steps of treatment are as follows:
- You will have an intravenous (IV, into a vein) line placed in your hand or arm or your central line will be used.
- You are given medication to prevent or lessen nausea and vomiting.
- You are given amino acids through your IV. This is used to protect your kidneys from being damaged by the radiation.
- The radiopeptide is then given through your IV, followed by more of the amino acid solution. After treatment, your IV will be taken out. Treatment takes about 4-6 hours.
Whether or not you stay overnight in the hospital depends on the local regulations/laws and which radionuclide was used.
What happens after PRRT?
Some radiation remains in your body for a few days, and you will be taught how to keep family members safe at home. You may be told to:
- Stay a safe distance from other people.
- Sleep in a room by yourself.
- Practice safe bathroom use (the radiation is excreted in urine and stool).
- Restrict your travel and work.
Your care team will talk with you and your caregivers about any special precautions you might need to take.
What are the side effects of PRRT?
The most common side effects of PRRT are:
- Nausea and vomiting. The amino acid infusion is what can cause nausea and vomiting. Medications will be given to lessen this side effect.
- Low blood counts which often happen a month or more after treatment.
- Kidney or liver damage but this is rare.
- Secondary cancer which is cancer that happens later in life and is caused by treatment for an original cancer.
Talk to your provider about any side effects you are having. Most side effects can be managed. Your blood counts and labs will be monitored to see how your body is responding to the treatment.
Will my insurance pay for PRRT?
The FDA in the United States and the EMA in the European Union have approved the use of a radionuclide, lutetium Lu 177 dotatate (Lutathera®), to be used with PRRT. You and your care team should look into coverage and if precertification is needed before treatment. Co-pay assistance may be available for commercially insured individuals (NOT for those with Medicare/Medicaid). PRRT is offered at centers in Europe and Asia but may require an out-of-pocket payment.
Resources for More Information
What Is Peptide Receptor Radionuclide Therapy (PRRT)? Fact sheet from the Society of Nuclear Medicine and Molecular Imaging
Chau, J., Yu, N., Bakeri, H., Dillon, J.S., Chandrasekharan, C. (2020). Real-world analysis of peptide receptor radionuclide therapy (PRRT) in the treatment of neuroendocrine tumors. Journal of Clinical Oncology, 38(15). Retrieved from https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.e16701.
Kayano, D., & Kinuya, S. (2018). Current Consensus on I-131 MIBG Therapy. Nuclear medicine and molecular imaging, 52(4), 254–265. https://doi.org/10.1007/s13139-018-0523-zNational Comprehensive Cancer Network (NCCN). (2022). NCCN Guidelines for Patients: Neuroendocrine Tumors. Retrieved from https://www.nccn.org/patients/guidelines/content/PDF/neuroendocrine-patient.pdf
Radiation therapy for pancreatic neuroendocrine tumor. American Cancer Society. (2018, October 30). Retrieved March 24, 2023, from https://www.cancer.org/cancer/pancreatic-neuroendocrine-tumor/treating/radiation-therapy.html
Shah, M. H., Goldner, W. S., Benson, A. B., III, Bergsland, E., Blaszkowsky, L. S., Brock, P., Chan, J., Das, S., Dickson, P. V., Fanta, P., Giordano, T., Halfdanarson, T. R., Halperin, D., He, J., Heaney, A., Heslin, M. J., Kandeel, F., Kardan, A., Khan, S. A., Kuvshinoff, B. W., II, Lieu, C., Miller, K., Pillarisetty, V. G., Reidy, D., Salgado, S. A., Shaheen, S., Soares, H. P., Soulen, M. C., Strosberg, J. R., Sussman, C. R., Trikalinos, N. A., Uboha, N. A., Vijayvergia, N., Wong, T., Lynn, B., & Hochstetler, C. (2021). Neuroendocrine and Adrenal Tumors, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology, Journal of the National Comprehensive Cancer Network, 19(7), 839-868. Retrieved Mar 24, 2023, from https://jnccn.org/view/journals/jnccn/19/7/article-p839.xml