Peptide Receptor Radionuclide Therapy (PRRT) in India

How does PRRT Work?

Peptide Receptor Radionuclide Therapy (PRRT) is a highly targeted and effective form of radiopharmaceutical therapy (RPT) with minimal side effects for treating NETs with an abundance (or overexpression of somatostatin receptors.  In PRRT, the patient receives an intravenous injection of a drug such Octreotide (DOTATOC) and Octreotate (DOTATATE) that is chemically bound to (or radiolabeled with) a radioactive material mainly lutetium-177. Other radiopharmaceuticals include yttrium-90, or indium-111.  The radioactive drug binds octreotide to the somatostatin receptors on the tumor cells and the tumor cells with radiation.
PRRT with 177Lu-DOTATATE was FDA approved in 2018 for the treatment of gastroenteropancreatic neuroendocrine tumors. There are ongoing clinical trials featuring other radiopharmaceuticals, isotopes, peptides and combinations with other therapy.

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What conditions are treated with PRRT?

PRRT is used to treat NETs, including the gastro-entero-pancreatic NETs, namely NETs arising from the stomach, intestine or pancreas, also known as carcinoids and islet cell carcinomas of the pancreas, which represent the current U.S. Federal Drug Administration (FDA) approved indication. PRRT is an option for patients:

• Who have advanced (metastatic) and/or progressive (e.g. to SSA) neuroendocrine tumors positive on somatostatin receptor imaging (e.g. 68Ga-DOTATATE/NETSPOT or 64Cu Dotatate/Detecnet) which are radioactive tracers used with PET/CT or PET/MR machines.
• Who are not candidates for surgery
• Whose symptoms do not respond to other medical therapies

Benefits of PRRT include symptom relief, slowing tumor progression and improving overall survival.
Nuclear medicine is a specialization of radiology that involves the diagnostic and therapeutic use of radioactive materials (radiopharmaceuticals). Nuclear medicine imaging is used to examine the structure and function of internal organs and to aid in the early detection of abnormalities or diseases. Certain types of cancer and disorders are also treated with this discipline of medicine.
A small amount of radioactive materials is employed in diagnostic procedures to assist in viewing the organs, allowing the doctor to discover and identify the abnormalities, size of any tumors, and other physiological or functional problems with the organ.
This approach can also be used to track the course of the disease and its response to treatment. The procedure involves injecting radiopharmaceutical agents into the patients and imaging with PET (Positron Emission Tomography) or SPECT (Single Photon Emission Computed Tomography) cameras. The emission spectra produced by the radiopharmaceutical substances utilized can be read using these approaches.

What is PRRT Treatment?

Peptide Receptor Radionuclide Therapy (PRRT) is a molecular therapy for neuroendocrine tumors that is one of the accepted treatment options (NETs). A radiopeptide is made by mixing a small amount of radioactive material (Yttrium-90 or Y-90 and Lutetium-177 or Lu-77) with a cell-targeting protein in PRRT treatment. When injected into a neuroendocrine tumor patient’s bloodstream, this radiopeptide travels to the cancer cells and attaches to them, delivering a high dosage of radiation that solely targets the cancer cells.

Who is eligible for PRRT Treatment?

PRRT Treatment in India is recommended for patients with Advanced Metastatic or Progressive Neuroendocrine Tumors (NETs), as well as those NET patients who are ineligible for surgery or who are unresponsive to conventional treatment options, also called PRRT Therapy for Neuroendocrine. While PRRT is a palliative treatment, it can help to relieve symptoms, reduce or even stop tumor progression, and so improve not only the quality of life but also the survival rate.

The doctor’s decision to use PRRT Therapy  to treat a Neuroendocrine Tumor patient is based on the following factors:

1. The tumor’s origin point
2. Tumor’s aggressiveness and proliferation
3. Tumor’s growth or stability – how aggressively is it growing?
4. The most crucial factor for clinicians to examine is whether the tumor expresses the receptors that are utilized to target PRRT.

Is PRRT Safe for you?

When compared to neuroendocrine tumors originating from the small intestine and the rectum, neuroendocrine tumors arising from the lungs and pancreas are generally more aggressive. Tumors that start in the gut and rectum have a higher chance of spreading to the liver than tumors that start in the lungs. The progression of a neuroendocrine tumor that originates in the lungs is more indolent (lazy).

How Does PRRT Work?

Some neuroendocrine cells have proteins (receptors) on the outside of them called somatostatin receptors. The hormone somatostatin attaches to these receptors and causes changes in the cell. For example, they may tell the cell to slow down the production of hormones.
Special scans such as PET scans or octreotide scans can check whether the NET has these receptors. If the NET has somatostatin receptors, doctors can use them to target radiotherapy.
Doctors connect a radioactive material to a man-made type of the hormone somatostatin in the lab (a somatostatin analogue). This radioactive treatment travels through your body’s bloodstream and binds to the NET cells’ somatostatin receptors. The creature then enters the cell and kills it from within.

How is the PRRT Therapy session performed?

A set of four PRRT treatments with 177 Lu-DOTATATE spaced about 8 weeks apart is the most common procedure. Protocols may differ depending on the location. This treatment may be performed as an outpatient procedure or may necessitate a few days in the hospital. This treatment is usually done as an outpatient procedure lasting half or full day, with only a few exceptions where a patient may need to stay overnight in the hospital.
Anti-nausea pre-medications are given before each PRRT session, followed by an amino acid solution. The amino acid solution is given intravenously to protect the kidneys of the patient from the treatment’s side effects. After that, the radioactive substance is delivered into the patient, which takes around 30 minutes, and an additional amino acid solution is given to the patient. The treatment session lasts about four to five hours in total.
Post-treatment Although this scan is not required as part of the FDA label for treatment, it can be done during and after the treatment to see where the injected radioactive medication has moved in the body.

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Side Effects of PRRT Therapy?

The PRRT itself is well-tolerated, but the amino acid solution administered for kidney protection might cause nausea and vomiting in certain patients, especially with certain types of amino acid solutions.
Anti-nausea medicine or slowing down the amino acid infusion can help with this. A lowering of blood cell counts, which is mild to moderate in the majority of instances, is one of the long-term side effects.
Long-term side effects, such as persistent kidney damage or the emergence of secondary blood problems (referred to as myelodysplastic syndrome), are uncommon. The majority of patients tolerate the treatment well.
Patients who have had PRRT should have some nausea and pain medications on hand for the return trip home. During the PRRT, if a patient has nausea, vomiting, or pain, they are usually given drugs right away.
The most common side effects are as follows:

• Vomiting and nausea
• Abdominal dissatisfaction or pain

Some of the less prevalent side effects are as follows:

• Toxicity in the blood (subacute)
• Temporary Hair loss 

As a result, PRRT frequently has fewer side effects than chemotherapy. PRRT is a highly effective treatment option for advanced neuroendocrine tumors that are progressing. PRRT is not a cure, but it has been shown to significantly lessen symptoms and slow the progression of the disease.

What are the potential benefits to patients?

PRRT is generally delivered over the course of four four-hour infusions. The treatment is designed to slow the progression of disease in gastroenteropancreatic NET patients and to reduce the severity of disease side effects, such as diarrhea.
As a targeted therapy, PRRT offers patients more personalized, precise treatment, with medications tailored to the unique characteristics of each patient’s biology and the molecular properties of the tumor, while limiting radiation exposure to healthy tissue.

Q: How long does PRRT treatment last?
A: This is referred to as the therapy response duration. This suggests that a single PRRT therapy can be successful for almost two years, causing tumors to retreat and die.

Q: How long are you radioactive after PRRT?
A: You will be mildly radioactive after PRRT. As a result, you may need to stay in the hospital for one or two days to ensure that the radioactivity is at a safe level before returning home. If you are feeling well, you may be allowed to go home later the same day in some hospitals.

Q: Does PRRT affect the immune system?
A: In addition to disrupting the tumor cell cycle through ionizing radiation administration, PRRT can also trigger an anti-tumor immune response.

Q: When should I use PRRT?
A: Patients with somatostatin receptor-positive gastroenteropancreatic NETs (common neuroendocrine tumors of the stomach, rectum, pancreas, and small and large intestine) should receive PRRT.

Q: What is a carcinoid crisis?
A: Carcinoid crisis is characterized by intense flushing, low blood pressure, confusion, and trouble breathing. When persons with carcinoid tumors are exposed to particular triggers, such as anesthetics used during surgery, a carcinoid crisis can occur. Carcinoid crisis is potentially lethal.

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• Visa assistance, Providing Visa Invitation Letter (VIL)
• Providing full guidance how to get Visa from your country
• Providing total cost including treatment, air tickets, accommodation, and food
• Assitance to book flight ticket from your country
• Arranging airport pick up/ drop
• Providing professional language interpreter
• Booking accommodation and guest house as per your budget/ prefrence
• Providing help in money exchanging
• Providing local sim card
• Arranging video consultation with specialist doctor if case requires

Get Opinion From Doctor

We offers these Services

• Providing a doctor’s opinion and proper quotation
• Selecting the best hospital and doctor as per your case
• Arranging a call with the doctor (if the case required)
• Visa assistance, Providing Visa Invitation Letter (VIL)
• Providing full guidance how to get Visa from your country
• Providing total cost including treatment, air tickets, accommodation, and food
• Assitance to book flight ticket from your country
• Arranging airport pick up/ drop
• Providing professional language interpreter
• Booking accommodation and guest house as per your budget/ prefrence
• Providing help in money exchanging
• Providing local sim card
• Arranging video consultation with specialist doctor if case requires