Peptide Receptor Radionuclide Therapy (PRRT)

Posted on January 21, 2013


A novel Nuclear Medicine procedure is launched in SA – hope for many cancer sufferers and a first in Africa!


The new (for SA) PRRT procedures make use of the Lu-177 isotope labelled (i.e. attached) to a peptide (e.g.DOTATATE) to seek and attack neuroendocrine tumours (NETs) which can occur at many locations in the body but mostly in the gastrointestinal tract, lungs and pancreas. This it does by selectively irradiating and destroying tumours to which it attaches whilst leaving healthy tissue unharmed. NETs are very difficult to detect and deal with using conventional medical procedures such as conventional X-ray and MRI scans for diagnosis and surgery and chemo- or radiotherapy for therapy. It is this cancer that caused the death of Apple founder and President, Steve Jobs and it strikes about 6 people in every 100 000, every year. Undetected and therefore untreated, NETs are almost invariably fatal.


NTP has an exclusive agreement with a company in Germany (ITG of Munich) to market and sell Lu-177 for PRRT in Africa and other selected markets, until such time as we have built our own Lu-177 production facility which is scheduled for commissioning before the end of 2013. Of significance and to the credit of the co-operation between NTP and the Nuclear Medicine Department of Steve Biko Academic Hospital and of the University of Pretoria, the use of Lu-177 supplied by NTP for PRRT at the hospital was a first in Africa!  


The course of treatment for NETs comprises of 4 infusions  of 200 mCi Lu-177 each that are evenly spaced over a 12-month period. The diagnosis and determination of the size and location of NET tumours is achieved by performing a PET scan using Ga-68 DOTATATE obtained from a generator manufactured by  iThemba LABS. To monitor the progress of the treatment, patients undergo further Ga-68 DOTATATE PET/CT scans prior to each injection of Lu-177 DOTATATE and again, one or more times, for follow-up after the treatment is completed. Several hours following the administration of Lu-177 DOTATATE, the patient is again scanned to establish how well the Lu-177 has been absorbed by the tumour and therefore how likely it is to kill only the cancer cells, leaving healthy tissue unharmed.


Very good results have been achieved in Europe (Prof Baum of Bad Berka, also on the panel, is a world leader in this field) , Australia (where Prof Turner pioneered the treatment) and the US using Lu- 177 PRRT to deal with NETs and it is expected that the same successes will be achieved in South Africa. NTP obviously is confident that, as the success of the technique spreads to other hospitals and private practices, we will see a fast growing demand for Lu-177. We have Prof Sathekge to thank for initiating Lu-177 PRRT and placing it on a sound footing in SA and the rest of Africa.  It is hoped that medical aid schemes will shortly agree to reimburse patients for the cost of PRRT treatment and that State hospitals will also allocate realistic budgets to nuclear medicine departments for its use.


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