By Lori Newman, Brooke Army Medical Center Public AffairsJune 27, 2019
JOINT BASE SAN ANTONIO, Texas -- The Brooke Army Medical Center Nuclear Medicine Department now offers a new treatment for certain types of neuroendocrine tumors.
The use of lutetium Lu 177 dotatate was approved by the Food and Drug Administration in January 2018 for the treatment of somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs), including foregut, midgut, and hindgut neuroendocrine tumors in adults.
"BAMC is the first military treatment facility to provide this type of therapy, and the first center in San Antonio," said Air Force Lt. Col. Penny Vroman, Nuclear Medicine Department chief.
"Until this treatment was created and approved patients have been getting (other treatments) that were not as effective." Vroman said. "Data has shown that this therapy reduced the risk of this type of cancer spreading or growing, and some patients even had their tumors shrink."
The inpatient procedure consists of four IV infusions spaced eight weeks apart, which must be administrated by specially trained staff in a dedicated radiotherapy room.
"It's a radioactive substance that's injected through an IV into the patient," Vroman said. "It's targeted molecular therapy, or theranostics."
Theranostics is a field of medicine that combines specific targeted therapy based on specific targeted diagnostic tests. With a key focus on patient centered care, theranostics provides a transition from conventional medicine to a contemporary personalized and precision medicine approach.
"The patient receives two IV's during the treatment," Vroman explained. "One is an amino acid infusion to protect their kidneys and the other is the peptide receptor radionuclide therapy drug. The process takes about five to six hours to complete."
Only two patients have started this course of therapy at BAMC to date. Not all patients meet the criteria for the treatment. A Hematology/Oncology doctor makes the referral to the Nuclear Medicine Department for a consultation. If the patient is a candidate for the treatment, Nuclear Medicine personnel will order the medicine and begin the process of scheduling the procedure.
One of the patients who is currently receiving the therapy was referred by Army Lt. Col. (Dr.) Lindsey Graham, Hematology/Oncology Department.
These types of tumors are slow growing and someone's best chance is if they are found early and can be surgically removed, Graham explained. There isn't a cure for this type of neuroendocrine tumor, but it can be controlled with medications.
"It's like a chronic disease that may over time get worse, but if you take your medicines you can keep it from getting bad quickly," Graham said. "We really don't have a chemotherapy that will cause reliable shrinkage of these tumors.
"This type of therapy has been talked about in literature and presented at conferences for a while," Graham said. "Studies have shown this is an effective therapy for neuroendocrine tumors."
Before offering this treatment at BAMC, a comprehensive team of personnel from several departments throughout the hospital was formed. Staff members were training on the use of the drug, and checklists and policies were created to ensure the safety of staff members and patients because this medicine uses radiation to kills cancer cells.
"We make sure the radiopharmaceutical being used for treatments and diagnostic purposes are used safely," explained Dexter Brathwaite, physical science technician, Health Physics Service. "My role was to train the staff before we started to administer this therapy to the patient."
A dedicated radiopharmacist, who has had several years of additional training in nuclear medicine, handles these types of radiopharmaceuticals. A radiopharmaceutical is a radioactive drug used for diagnostic or therapeutic purposes.
"It is very much a team approach to this treatment," Brathwaite said. "We are working urgently to make sure it is a smooth process, and are hopeful this treatment will be a main staple offered here."
Graham and Vroman agree.
"I definitely love my team members in Nuclear Medicine," Graham said. "I'm so thankful they found out all the steps and hoops they had to go through to get approved to do this here."
"We are all very excited because we have been waiting for this type of targeted molecular therapy to treat these patients who have metastatic neuroendocrine tumors," Vroman said.