For many years, nuclear medicine has been used to treat neuroendocrine tumors in Europe, Australia, and other nations. After a multicenter clinical trial and expanded access protocol, it received FDA approval in the United States in 2012. Radiation is delivered directly to the tumor during this procedure to kill cancer cells.
Neuroendocrine tumors (NETs) are treated using molecularly targeted therapy, also known as PRRT therapy in India. Drugs or other substances are used in targeted molecular therapies to target cancer cells while minimizing damage to healthy tissue. To eliminate or slow the growth of tumors and reduce the side effects of the disease, PRRT administers high radiation doses to the affected areas of the body.
Nuclear medicine therapy cost in India is quite affordable in comparison to other European nations. Diagnoses, evaluations, and types of treatments for conditions like cancer, heart disease, gastrointestinal, endocrine, or neurological diseases are included in the cost.
What is Peptide Receptor Radionuclide Therapy (PRRT)?
The major goals of PRRT therapy in India are to reduce symptoms and improve quality of life while also slowing or controlling the growth of the tumor, though it rarely completely eliminates it. Results vary from patient to patient, so it is best to talk about this with your particular healthcare professional.
For the treatment of NETs with an excess of (or overexpression of somatostatin receptors), peptide receptor radionuclide therapy (PRRT) is a highly targeted and effective radiopharmaceutical therapy (RPT) with few side effects.). During PRRT, the patient receives an intravenous injection of a medication such as octreotide (DOTATOC) or octreotate (DOTATATE), which is chemically bound to (or radiolabeled with) a radioactive substance, primarily lutetium-177. Yttrium-90 and indium-111 are examples of additional radiopharmaceuticals. The somatostatin receptors on the tumor cells are where the radioactive drug binds octreotide, irradiating the tumor cells in the process.
In 2018, the FDA approved PRRT using 177Lu-DOTATATE for the treatment of gastroenteropancreatic neuroendocrine tumors. Clinical trials using additional radiopharmaceuticals, isotopes, peptides, and combinations with other treatments are currently being conducted.
What are Neuroendocrine Cells?
Like nerve cells, neuroendocrine cells are capable of producing and releasing hormones. They are responsible for making sure the body processes are efficient. Most of these cells have unique “switches” (called receptors) on their surfaces that allow them to turn other cells on and off.
They accomplish this by:
- Taking in (sensing) messages from their surroundings.
- Releasing hormones and other chemicals to regulate a variety of bodily processes, including metabolism, body heat, and digestion.
What are Neuroendocrine Tumors?
Neuroendocrine tumors (NETs) are caused by the uncontrolled division and transformation of neuroendocrine cells. Through the bloodstream, these cells may disperse and infect different body parts. These tumors can also overproduce hormones and other chemicals, which can result in a variety of symptoms like diarrhea and flushing.
Primary or secondary tumors are the two categories of neuroendocrine tumors. Cancer that has not spread to other parts of your body is referred to as a primary tumor. A NET that has metastasized—typically to the lymph nodes in your lymphatic system, liver, or bones—is referred to as a secondary tumor. Location determines the NET type.
For instance, a neuroendocrine tumor of the gastrointestinal tract is one that develops in the gut. The following are the various categories of primary neuroendocrine tumors:
- Gastrointestinal (GI) Tract: The GI tract, specifically the large intestine (20%), small intestine (19%), and appendix (4%), is where NETs occur most frequently. The GI tract is extremely important to the digestion of food and liquids as well as the elimination of waste. Carcinoid tumors were the previous name for GI tract NETs.
- Lung: The second most typical location for NETs is the lung. The bronchial system, which carries air to the lungs, is where about 30% of NETs develop.
- Pancreas: The pancreas, a pear-shaped gland situated in your abdomen between the stomach and the spine, can develop in about 7% of NET cases. PNETS, also known as pancreatic islet cell tumors.
How PRRT Therapy is Performed?
This varies according to the treatment facility and the type of radionuclide being employed. As different PRRT therapy for cancer treatment is used. Up to 10 treatments may be given to a patient, spaced anywhere between 6 and 12 weeks apart. The following are the treatment’s steps:
- Medication is given to patients to stop or lessen nausea and vomiting.
- They then receive an intravenous infusion of amino acids (IV, into a vein). By doing this, the kidneys are protected from radiation damage.
- The radiopeptide is then administered via IV, followed by an additional amino acid solution.
- It may take this treatment four hours or longer.
Depending on the local laws and regulations and the radionuclide used, the patient may or may not spend the night in the hospital. You will be given instructions on how to keep family members secure at home because some radiation persists in the body for a few days. Following treatment, you might be given instructions that include temporary isolation (keeping a safe distance from others and sleeping alone in a room), safe bathroom use (radiation is excreted in urine and stool), and any travel restrictions. Your care team will discuss the certain unique safety measures you might need to take with you and your caregivers.
However, the PRRT therapy cost in India is around USD 14600. The following are the variables influencing the cost of PRRT therapy in India:
- The individual’s preferred hospital.
- Your nuclear medicine specialist team fees (Medical oncologist, caregiving staff, dietician, etc).
- Cost of both conventional and nuclear medicine.
- Per day cost for the radiation room and the safety room
- Charges for routine diagnostic and testing procedures.
- Depending on the techniques used and the type of nuclear medicine used
What are the Benefits of PRRT Therapy?
More individualized cancer treatment is available with PRRT and other molecular therapies. Because these radioactive drugs can specifically target and damage neuroendocrine tumor cells while limiting radiation exposure to healthy tissue, PRRT is referred to as targeted therapy. PRRT is therefore typically well tolerated.
For the treatment of advanced, metastatic, or inoperable progressive neuroendocrine tumors, PRRT is a highly effective option. Although PRRT is rarely curative, studies have shown that it can help with symptom relief, tumor reduction, and disease progression slowing.
What are the Side Effects of PRRT Therapy?
In most cases, PRRT therapy is very well tolerated. Some side effects can occasionally be felt by patients. Your doctor will go over these with you and, if necessary, prescribe medication. Below are a few possible short-term side effects:
- A flare-up of hormone-related symptoms
- A little pain at the site of your tumor
Additional harmful impacts include:
- A transient drop in platelets and white blood cells. If this is the case, additional PRRT will be administered once the blood counts reach an acceptable level of recovery.
- A temporary (short-term) decline in liver function in patients who have a significant volume of liver tumors.
- To protect the kidneys from potential damage, an infusion of amino acids is administered throughout the course of treatment. Patients who have a known kidney condition are the most at risk.
- A rare but more severe long-term side effect is the potential emergence of the bone marrow disorder known as Myelodysplastic Syndrome (MDS), which can result in leukemia.
Prior to treatment, your Nuclear Medicine Specialist will go over all possible side effects, risks, and benefits with you.
Like any other therapy, PRRT carries some risks and side effects. Patients are advised to discuss the risks and advantages of PRRT therapy with the specialist doctors at the center. Based on the patient’s medical history, the doctors at the center will decide if the therapy is the best option for the patient. Additionally, it is advised that patients let the team know about any prior treatments they may have received because this information may help them choose the right therapy and dosage.
You will receive instructions from your medical facility regarding any special after-treatment care that needs to be taken. Patients must adhere to your facility’s radiation safety protocol because small amounts of radiation temporarily stay in the body. Following PRRT therapy, may entail keeping a safe distance from others for a few days and practicing careful and thorough hygiene. It’s absolutely essential to develop good bathroom hygiene during this time because the radioactive drug is primarily eliminated from the body through urine and feces.