Neuroendocrine cancer - Lutate services NSW

What is Lutate?

Lutate (¹⁷⁷Lu-DOTATATE) treatment is used to treat some neuroendocrine tumours (NETs).

It is a type of targeted internal radiotherapy called peptide receptor radionuclide therapy (PRRT).

Lutate treatment:

• uses a radioactive substance – radionuclide, Lutetium–to177
• combines a manmade hormone –peptide somatostatin analogue with the radionuclide
• is when the peptide somatostatin analogue combined with the radionuclide,  attaches to a receptor on the surface of the NETs cells (similar to a lock and key effect), and the  radionuclide is released into the NETs cells destroying them.

Lutate treatment is given intravenously (in a drip) in the nuclear medicine department. The patient will be radioactive for a while following lutate treatment.

In NSW, Lutate is used when there is progression of the NETs after other recommended treatments have stopped working.

It is accessed via the Therapeutic Goods Administration’s Special Access Scheme.

Designated Lutate services

NSW has two designated Lutate services.  Both of these services participated in NSW Health’s evaluation of Lutate therapy ¹ and treat patients according to the NSW Lutate therapy referral and protocol for neuroendocrine cancer patients  ². Both services have a neuroendocrine tumour multidisciplinary cancer care team that reviews patients referred for Lutate treatment.  Patients must meet the suitability criteria before Lutate treatment can be considered ².

Multidisciplinary cancer care team

Patients with NETs may have one or more types of treatment, including surgery, chemotherapy, somatostatin analogue therapy, and radiation therapy. A multidisciplinary cancer care team (MDCCT) brings together health care professionals from different specialties to discuss a patient’s cancer diagnosis and staging, and their treatment options. It also enhances communication and care co-ordination between the specialists involved in a patient’s care.

Evidence suggests that patients overseen by a MDCCT experience better outcomes after cancer treatment ³.

If the treating MDCCT decides a patient could benefit from Lutate treatment they are to refer the patient to one of the two lutate services in NSWs.

Actions for Health Professionals

Patient referral

Patients with a neuroendocrine tumour, for whom a multidisciplinary team (MDT) has established that Lutate is a valid treatment option, should be referred to one of the NSW Lutate services listed.

The Canrefer website allows you to find cancer specialists who are MDT members, and has information about cancer services, optimal care pathways, and patient resources.

Smoking cessation support

Evidence suggests that tobacco cessation following cancer diagnosis improves survival. It also reduces treatment-related complications.[13–14] Health professionals should discuss tobacco use with all patients and provide appropriate cessation support.

List of NSW Lutate services

Local Health district	Hospital
Northern Sydney	Royal North Shore Hospital
South Eastern Sydney	St George Hospital

References

1. Lin E, Chen T, Little A, Holliday L, Roach P, Butler P, et al. Safety and outcomes of (177) Lu-DOTATATE for neuroendocrine tumours: Experience in New South Wales, Australia. Internal medicine journal. 2019.
2. Nuclear Medicine Network and Cancer Institute NSW. NSW Lutate therapy referral and protocol for neuroendocrine cancer patients Sydney, Australia: NSW Agency for Clinical Innovation; June 2017 [Available from: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/255451/NSW-Lutate-therapy-referral-protocol–to2017.pdf.
3. Laskaratos FM, Caplin M. Treatment challenges in and outside a network setting: Gastrointestinal neuroendocrine tumours. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2019;45(1):52–to9.
4. Karam-Hage M, Cinciripini PM, Gritz ER. Tobacco use and cessation for cancer survivors: an overview for clinicians. CA: a cancer journal for clinicians. 2014;64(4):272–to90.
5. Warren GW, Sobus S, Gritz ER. The biological and clinical effects of smoking by patients with cancer and strategies to implement evidence-based tobacco cessation support. Lancet Oncol. 2014;15(12):e568–to80.
6. Florou AN, Gkiozos IC, Tsagouli SK, Souliotis KN, Syrigos KN. Clinical significance of smoking cessation in subjects with cancer: a 30-year review. Respiratory care. 2014;59(12):1924–to36.