I had the third Peptide Receptor Radioisotope Therapy (PRRT) on Friday three days ago.
So far, there is not a lot to report. The side effects seems to be less severe and less frequent than they were for the earlier treatments.
In fact, each treatment seems to “get better”. I told this to one of the nurses in the clinic today when I went in for my monthly Sandostatin injection. She said “You must be getting used to it.” I said, “I’m not sure that it’s good to get used to being highly radioactive!”
The symptoms that I have had so far since the third treatment:
Fatigue – very definitely need a long nap in the afternoon and not much will to do anything physical.
Lower abdominal pain – each morning for a half hour or so there is sharp pain in my lower abdomen.
Nausea – a little nausea every morning and yesterday morning, I worked on cleaning a gutter in the morning and the nausea took over much more intense for 4 to 5 hours. I better wait a week to do any more of that.
Joint/muscle pain – I awoke this morning with rather difficult pain in many of my joints joints, mostly those with noticeable arthritis or old injuries. It reduced very much in severity after 30 to 60 minutes. It is still there five hours though.
All the above happened after the other treatments, but this has been less severe so far.
As I have published here before, I have really enjoyed producing music using the VCV Rack software (open-source virtual modular synthesizer).
A couple of days ago, VCV Rack finally left beta testing and became full production software. I have been waiting eagerly for this, so, the very first day it was available, I installed it. My first trial of it on that first day is below.
I found the usage better, easier and the computer efficiency better. The graphics and audio appear to have improved as well.
The NET Research Foundation is pleased to invite you to join the 2019 Denver NET Patient and Caregiver Education Conference on Saturday, August 10, 2019, at the Sheraton Denver Tech Center.
This full-day conference will include experts from the Rocky Mountain
region. Our agenda includes speakers like Dr. Eric Liu, Dr. Lauren
Fishbein, Dr. Heloisa Soares, and Dr. Mark Lewis.
Except for one thing. My blood pressure spiked very high during the actual infusion of the Lutathera. One nurse said that she had never seen blood pressure that high. Now, 24 hours later, it has reduced to much less high but still not in the normal range.
The clinic doctor and nurses had me make an appointment with my cardiologist for within the next week. It should be interesting since I am already taking the maximum of my current bp medication.
For three to four years I had invasive bladder cancer procedures and a BCG (immune system treatment) to try to rid me of bladder cancer.
Today, I had another cystoscopy check for bladder cancer. There was none there! WOO! HOO!
It has been about three years since my last treatment. I can now go on a schedule of one checkup every year, instead of twice a year. As you might guess, it is a great relief to be able to worry about only one cancer instead of two.
“Beware the Ides of March!” may have been suitable for Julius Caesar, but the Ides have been good to me this year. Yesterday was 2 weeks after my 1st PRRT treatment and all is well.
The first week after PRRT, I had some of the symptoms which were predicted: nausea (not much), pain in abdomen ( only once or twice a day, fatigue ( i was sleeping almost 12 hours a day), Joint and muscle pain for parts of my day.
The second week after PRRT, much of the fatigue is gone, there has been indigestion on a couple of evenings, the abdominal pain has stopped occurring. The joint and muscle pain is still with me but is tolerable.
I am no longer a radiation danger to children, so I can see my grandchildren.
For about a week, I have been walking outdoors for a half hour to a full hour (not fast but steady)(except for the day of the blizzard when I shoveled snow).
A few day ago, I had my first lab test. These tests will be repeated every two weeks during the cycle of treatments to make sure that the PRRT is not lowering my white blood cell count too much. I was told that the count will be lower and will not bounce back, so we must make sure that it is not going too low.
Three more treatments to go! They say that each treatment can produce different symptoms with different severity for any patient. Also, we cannot know how effective the treatments have been until I have a scan after the last treatment late this year.
My next treatment may be in about six weeks. We may have to schedule it later because of travel plans.
Laurie and I are going to the Yucatan Peninsula in late April and hoping that my radioactivity does not screw up the travel. We also want to visit our son and his family in Scotland in the late spring/early summer again worried about my radioactivity. We will see.
NOTE: Others who have had PRRT have told me that the procedures in the clinic they used were different. For instance, instead of a PICC line, the clinic used a standard IV. Do not expect everything to be similar.
Friday, March 1st was my first PRRT (Peptide Receptor Radionuclide Therapy). Today, Saturday, March 2nd, I slept well, did not wake up with Spiderman or Incredible Hulk powers and I am not feeling sick from the treatment. Perhaps a little fatigue and a tiny bit of upset stomach. I also have a cold so the symptoms could be related to that.
It went well. On Thursday I went to Presbyterian/St. Luke’s Hospital and had the PICC Line inserted. The wonderful Radiology team there were friendly, helpful and informative. The only discomfort was the initial little prick in my arm to insert the PICC Line. The actual process took only about 6 minutes. The line was inserted into a vein in my inner, upper arm and run to within about 4 cm (1.5 inches) from the top of my heart. No complications except my pacemaker was on my right side which they had expected to use so they used the left side. We don’t want to disturb those wires, right?
At 7:30 AM on Friday, I arrived at the Rocky Mountain Cancer Center (Dr. Liu’s offices), had my vitals checked and went to the infusion room to start the process. For those of who do not know (lucky you), an infusion room is a room with a lot of recliner chairs for patients and other chars for family. The patients there get chemo and other treatments. They had a few chairs set aside for PRRT patients. I and a man named Billy from Texas were there for the PRRT. Billy is about my size and age and he is apparently much sicker from the disease than I.
All of the nurses, nuclear medicine staff, in fact everyone at RMCC were friendly and helpful throughout. They went to great trouble to explain every step. What a great group!
Once I was in the infusion chair, my nurse checked and flushed the PICC line. She then injected a short acting anti-nausea and an antacid through the IV.
Once the anti-nausea medication was finished, The amino acids were started and increased incrementally as tolerated. The IV anti-nausea meds would be continued throughout the treatment and would be the last thing removed at the end of the day. I only had a tiny spot of nausea at one point. Billy the Texan, experienced a lot of nausea during the treatment. He told me that his NETs symptoms included a lot of nausea so it was a terrible experience for him.
After the anti-nausea IV was going well, we were moved to the another floor, the Radiology/Nuclear Medicine dept. where the LUTATHERA would be added to the IV.
The LUTATHERA is started 30-45 minutes after the amino acids are started. The infusion lasts about 40 minutes. My Nuclear Medicine tech checked the level of radio activity at my heart and at an area that has several tumors. Fortunately, for me, there were no problems. Billy, I think was quite nauseous and sick.
Once the Lutathera had been administered, we were moved back up stairs to the infusion room. We each got a small private room with a bed to rest on. There was one of those radiation signs (see the image at the top of this blog) and my name on the door.
There was a bathroom exclusively for PRRT patient use. There were two signs on the door which said “DANGER, do not enter“. Seemed a bit daunting, however we were required to void our bladders at least twice in the next two hours to make sure the kidneys were working. The bathroom had paper taped to the floor. The toilet bowl was completely covered in plastic cling type wrap. After voiding, we were instructed to cover the toilet seat with a special pad and flush three times. This is an attempt to keep all body fluids confined to the toilet.
Once in the room, I was asked if I wanted anything to eat. Most of the available food was snacks which were OK. I got to eat Ramen noodles, Cheese Crackers, coffee and water. Obviously, I was not nauseous. It went down fine.
Once the amino acid infusion was finished (between two and three hours after the actual LUTATHERA), my nurse removed the PICC line. This was almost instantaneous and painless. She just said look the other way until I say you can turn back. I looked away and she said OK and there she was holding the thing. After that, just bandaging the entry point and I drove myself home!
Now this experience must be repeated three more times eight weeks apart.
I am scheduled to have the first of four PRRT treatments on Friday, March 1st. Today, February 26, I had a meeting to learn about it and the rules for me and to have the blood tests which will be the benchmark for the blood tests that I will have every two weeks for the next none months.
First, I have done a little explanation of PRRT in this previous post. Here is another attempt at clarification:
PRRT – Peptide Receptor Radionuclide Therapy
P – Peptide: In the case of this treatment the peptide is a somatostatin analog similar to octreotide. Somatostatin is an endocrine hormone made by our own bodies. Octreotide is a commercially made chemical very similar to somatostatin that many people with NETs (like me) have injected into their rear ends every month or more
peptide /pep·tide/ (pep´tīd) (pep´tid) any of a class of compounds of low molecular weight that yield two or more amino acids on hydrolysis; known as di-, tri-, tetra-, (etc.) peptides, depending on the number of amino acids in the molecule. Peptides form the constituent parts of proteins.
R – Receptor: Neuroendocrine tumors have (or express) receptors on their surface that attempt to bind with somatostatin as it passes by in the blood stream. Unfortunately, only 80% of the receptors are active, so any particular patient may not be a good candidate for PRRT if their receptors are not active. Also, even if most of a patients tumors have active receptors, they may not all be active. PRRT is said to be 75% likely to have positive effect.
R – Radionuclide: A chemical substance, called an isotope, that exhibits radioactivity. In the GA-68 scans which I have written about, Gallium-68 is the isotope. It is not radioactive enough to worry much about damage to the patient. In PRRT the radionuclide is Lutetium-177. This is strong enough to damage the tumor cells but not to damage the patient, if controlled. The brand name of the Lutetium-177 and octreotide combination is LUTATHERA distributed by: Advanced Accelerator Applications USA, Inc., NY 07041
T – Therapy: This therapy directly targets the molecules of the tumors. Because it works over the whole body, can be ideal for someone like me who has tumors in the liver, the pancreas, behind my eyes in the skull, in three vertebrae and in my abdominal wall. This will probably not eradicate the disease but the goal is to shrink the tumors and be stable (progression free) for three to four years (average). If or when progression occurs it can be repeated.
There are many places to look for more detail. Try these:
It was more than information. NOTE: Bear in mind that everything below will be particular to Rocky Mountain Cancer Center (RMCC), Dr. Liu’s offices. Not all clinics will have identical procedures.
The PRRT will be done four times, once every eight weeks. Today’s blood lab tests will form a benchmark to compare with lab tests that will be done every two weeks for nine months! This is to closely monitor my blood cell count to make sure that the radiation is not making it too low.
On Thursday, the day before PRRT, I will go to RMCC and they will insert a PICC Line. This is a long flexible IV tube running through my vein to a near the intake valve of my heart. I have been told that most clinics do not use a PICC line, they use standard IVs instead. The PICC Line will be removed after the treatment is given on Friday.
On Friday, the day of treatment, the whole process should take 5 or 6 hours.
1 hour before the LUTATHERA, I will be given a short acting anti-nausea medication and an antacid through the PICC. then a longterm anti-nausea through the IV. These are because the next step is known to cause nausea in many patients. I am told it is better now than it used to be!
At this an infusion of amino acids will begin. The purpose of these amino acids is to protect the kidneys from radiation. I am told that our kidneys are among the most sensitive organs to radiation yet in this therapy, they must clean it all out of the bloodstream ultimately.
The LUTATHERA infusion will start 30 to 45 minutes after the amino acids have started and will last about 40 minutes. Then there will be a saline flush.
The rest of the amino acid infusion will be finished and the PICC removed.
After the above process people must stay a designated distance from the patient. You are radioactive.
As long as all has gone well, the patient is released and can drive themselves home, if they wish.
Avoid close contact with people. Try to keep a distance of 3 feet for 3 days. During that time avoid public places.
Limit contact (3 feet) with children for 14 days.
For the first two or three days after treatment bedding, pajamas, clothing must be washed separately from other people’s laundry. They should be washed two or three times.
For any air travel, you must keep a discharge letter with you for at least 3 months after treatment.
Possible Side Effects (None are very common)
Interestingly, many of the listed side effects are the same as the side effects of Sandostatin (octreotide).
I asked if there was anything that could occur long term. PRRT has been blamed for leukemia in a few cases. Only one case was seen at RMCC a year after PRRT was given at a different clinic. There was no way to determine whether that patient would have developed leukemia anyway.
I will attempt to blog my personal experience with the therapy this weekend.