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Home > Neuroendocrine tumour Advanced - peptide receptor radionuclide therapy [PRRT] for pheochromocytoma/paraganglioma

Neuroendocrine tumour Advanced - peptide receptor radionuclide therapy [PRRT] for pheochromocytoma/paraganglioma

Treatment Overview

In appropriate patients, PRRT may be given in concurrently with temozolomide and capecitabine (in this case PRRT is given on day 10).

For temozolomide and capecitabine regimen, see Neuroendocrine tumour Advanced - capecitabine and temozolomide [TWICE daily dosing for use with PRRT].

Cycles 1 to 4 - 56 days

Cycle length:
56

In those with pheochromocytoma/paraganglioma domperidone, metoclopramide, morphine* and dexamethasone* are contra-indicated.

*Morphine and dexamethasone may only be used if patient is adequately alpha blocked.

Cycle details

Cycles 1 to 4 - 56 days

Medication Dose Route Days Max Duration
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
ondansetron 8 mg oral administration 1
LORazepam * [Dose - see details] oral administration 1
paracetamol 1000 mg flat dosing oral administration 1
ibuprofen * 400 mg oral administration 1
Vamin 18 * [Dose - see details] intravenous 1 250 minutes
lutetium Lu 177 dotatate 7.4 GBq (gigabecquerel) intravenous 1 40 minutes
ondansetron 8 mg Twice daily oral administration 2, 3
paracetamol 1000 mg flat dosing Four times daily oral administration 2, 3
ibuprofen 400 mg Three times daily oral administration 2, 3

In those with pheochromocytoma/paraganglioma domperidone, metoclopramide, morphine* and dexamethasone* are contra-indicated.

*Morphine and dexamethasone may only be used if patient is adequately alpha blocked.

Full details

Cycles 1 to 4 - 56 days

Day: 1

Medication Dose Route Max duration Details
aprepitant 125 mg oral administration
Instructions:

ONE hour prior to lutetium Lu 177 dotatate.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to lutetium Lu 177 dotatate if required for nausea and/or vomiting.
LORazepam * [Dose - see details] oral administration
Instructions:

0.25 mg to 1 mg 30 minutes prior to treatment if required for anxiety.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
paracetamol 1000 mg flat dosing oral administration
Instructions:

ONE hour prior to lutetium Lu 177 dotatate if required for pain crisis.
ibuprofen * 400 mg oral administration
Instructions:

ONE hour prior to lutetium Lu 177 dotatate with food if required for pain crisis.
Vamin 18 * [Dose - see details] intravenous 250 minutes
Quantity:2200 mL
Instructions:
  • Commence 30 minutes prior to initiation of lutetium Lu 177 dotatate, give continuously during, and for at least 3 hours after lutetium Lu 177 dotatate administration. 
  • Avoid extravasation.
  • An alternative proprietary amino acid solution or a compounded solution may be used, as per institutional practice, with:
  • Total dose of lysine HCl between 18 g and 24 g and arginine HCl between 18 g and 24 g in a volume of 1500 mL to 2200 mL.
  • Osmolality of less than 1050 mOsmol.
lutetium Lu 177 dotatate 7.4 GBq (gigabecquerel) intravenous 40 minutes
Instructions:
  • Use waterproof gloves and effective radiation shielding while handling and administering. 
  • When long-acting somatostatin analogs (e.g. octreotide modified release) are used, discontinue at least 4 weeks prior to administration of lutetium Lu 177 dotatate.

Day: 2

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.
ondansetron 8 mg Twice daily oral administration
Instructions:

When required for nausea and/or vomiting.
paracetamol 1000 mg flat dosing Four times daily oral administration
Instructions:

If required for pain crisis.

  • Maximum 8 tablets in 24 hours.
ibuprofen 400 mg Three times daily oral administration
Instructions:

If required for pain crisis.

  • Take with food.

Day: 3

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.
ondansetron 8 mg Twice daily oral administration
Instructions:

When required for nausea and/or vomiting.
paracetamol 1000 mg flat dosing Four times daily oral administration
Instructions:

If required for pain crisis.

  • Maximum 8 tablets in 24 hours.
ibuprofen 400 mg Three times daily oral administration
Instructions:

If required for pain crisis.

  • Take with food.

Supportive Care Factors

Factor Value
Emetogenicity: Variable

References

Advanced Accelerator Applications, S.r.l. Lutathera Prescriber Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/208700s000lbl.pdf (Accessed 22 February 2022).

Strosberg JR, Caplin ME, Kunz PL, et al; NETTER-1 investigators. 177Lu-Dotatate plus long-acting octreotide versus highdose long-acting octreotide in patients with midgut neuroendocrine tumours (NETTER-1): final overall survival and long-term safety results from an open-label, randomised, controlled, phase 3 trial. Lancet Oncol. 2021 Dec;22(12):1752-1763. doi: 10.1016/S1470-2045(21)00572-6. Epub 2021 Nov 15. Erratum in: Lancet Oncol. 2022 Feb;23(2):e59., PMID: 34793718

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.