PRRT Therapy in India

PRRT – Peptide Receptor Radionuclide Therapy

  • Peptide Receptor Radionuclide Therapy is a radioisotope therapy (also called molecular therapy) that is used for the treatment of certain types of cancer called Neuroendocrine Carcinoma or Neuroendocrine Tumours (NETs). 
  • The therapy is approved by the U.S. Federal Drug Administration (FDA) for the treatment of NETs that originate from the stomach, intestine or pancreas (carcinoids and islet cell carcinomas of the pancreas). 
  • Other types of NETs that can be treated with PPRT are pheochromocytoma, a rare tumour of the adrenal glands and rare thyroid cancer that does not respond to treatment with radioiodine.

Suitable candidates 

The treatment with PRRT is offered to patients who –

  • Have advanced stage (metastatic) or progressive NETs
  • Are not eligible for surgery
  • Fail to show improvement with other treatment options

How it works?

  • For PRRT therapy, a cell-targeting protein or peptide molecule (octreotide) is attached with a radioactive compound, also called a radionuclide. 
  • This results in the formation of a special type of radiopharmaceutical known as a Radiopeptide. 
  • This radiopeptide is injected into the patient and it reaches the neuroendocrine tumour and binds itself to the cancer cells. 
  • The radiopeptide then delivers a high dose of radiation to these cells. 
  • The most commonly used radionuclides in PRRT are Yttrium 90 (Y-90) and Lutetium 177 (Lu-177). 
  • The peptide molecule, octreotide, is a laboratory synthesized version of a hormone (somatostatin) that binds to a specific receptor present on most neuroendocrine tumours.

The aim of PRRT is to:

  • Provide relief from the symptoms
  • Stop or slow the progression of tumour
  • Improve overall survival

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Procedure 

The number of sessions and procedure details depend on several factors such as the type of cancer and the hospital facility. A patient usually needs four to six sessions but may vary up to 10 PRRT sessions, given a gap of two to three months.

  • The treatment is usually done as an outpatient procedure but may require hospitalization for a few days, depending upon the type of radionuclide used.
  • A session takes approximately four hours.
  • Patients are given an Amino Acid Solution intravenously before each PRRT session, to protect the patient’s kidneys from the radiation effects.
  • The radiopeptide material is then injected into the patient’s bloodstream.
  • An additional Amino Acid Solution is also administered at the end of the session.
  • Sometimes, Molecular Imaging Scans may be done during and after the treatment process to follow the path of injected radiopeptide inside the body.

As a small amount of radiation may remain in the body after the therapy, the patients are advised to follow precautions post-treatment, especially for the first few days. After discharge, the radiation safety protocol provided by the doctor has to be followed.

This includes maintaining a safe distance from other people for some days post PRRT therapy. It is also important to take care of the bathroom hygiene as per FDA recommendation as the remaining radionuclide leaves the body through urine and faeces.

Outlook 

  • While PRRT has been reported to be an effective treatment option for controlling advanced progressive Neuroendocrine Tumours, it is not a cure. 
  • Patients with Gastroenteropancreatic NETs who cannot undergo surgery are typically treated with hormone therapy. 
  • But when tumours still continue to grow despite this treatment, PRRT therapy is offered to control symptoms and tumour growth.

Advantages of PRRT

  • Molecular therapies such as PRRT provide more personalized and precise cancer treatment. 
  • The radionuclide can be customized to the specific biological characteristics of a patient and molecular properties of the tumour.
  • PRRT is a targeted therapy as the radiopeptides selectively attach and damage the neuroendocrine tumour cells. 
  • This limits radiation exposure to the healthy tissues around the tumour.
  • As the surrounding healthy tissues are not affected, the therapy has fewer side effects in comparison to chemotherapy.

Risks and side effects of PRRT

The major risks associated with PRRT arise from radiation toxicity. This may affect the production of Red Blood Cells, White Blood Cells and Blood Platelets, and kidney functions as well as liver functions.

Some common side effects of the PRRT for neuroendocrine tumour treatment include:

  • Nausea
  • Vomiting
  • Abdominal discomfort or pain

The less common side effects of the treatment include subacute haematological toxicity and temporary hair loss. Although serious hematologic toxicity is rare, some patients may have delayed toxicity to the kidneys and develop renal insufficiency.

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Dr. Surbhi Suden is one of the founders of Lyfboat and a doctor with a renowned name in the Medical tourism industry. She has been working with international patients since 2008 and is a deeply committed professional with a long term vision of transforming the current healthcare scenarios.
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