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Changing Amino Acid Infusion Rate Did Not Alter Renal Function, the Biodistribution and Subsequent Outcome of Lutathera Therapy: Report of an Experience Resulted by an Accidental Broken Lutathera Vial

Jitesh Dhingra*, Harry Schroeder, Saima Muzahir, Raghuveer Halkar

The use of peptide-receptor radionuclide therapy (PRRT) with Lutathera for metastatic neuroendocrine tumors (NETs) has demonstrated an increased progression free survival. [1] High concentration of Lutathera in the kidneys requires amino acid infusion pre and post administration of Lutathera to protect the kidneys from radiation effects. The ACR–ACNM–ASTRO– SNMMI practice guidelines and the IAEA, EANM, and SNMMI guidelines describe that the amino acid infusion should be started 30 minutes prior to 177-Lu Dotatate therapy and continued for 3 hours post 177 Lu-Dotatate. The rate of amino acid infusion should be 250ml/hour. [2] The literature on the effect of different infusion rates of amino acids on the biodistribution of Lutathera and subsequent outcome of therapy is limited. Here we report our experience of the effect of a slower infusion rate of amino acids on the biodistribution of lutathera and outcome of therapy. 38 year old male patient diagnosed with grade 2 small bowel well differentiated NET status post resection of the primary in 2018 came to the nuclear medicine department on December 12th 2019, 11:30 am for his first cycle of Lutathera, 177-Lu Dotatate. The pretreatment lab work showed a serum creatinine of 0.93 mg/dl, hemoglobin of 14.1 gm/dl and a normal platelet count. The technologist picked up the lead pig not realizing the cap was not tight. The pig and vial fell to the floor. The vial of Lutathera broke and the survey done by the Radiation Safety team showed contamination on the floor in the hot lab. The readings were over 200mR/hr at 1 meter. The patient had already started receiving the amino acid infusion at 250ml/hour.