Occurrence and Management of Acute, Subacute, and Delayed Toxicities in Patients with GEP-NETs Following Treatment with Radioligand Therapy

Radioligand therapy (RLT) offers the ability to deliver radiation to specific cells based on the presence of certain targets. RLT with [¹⁷⁷Lu]Lu-DOTATATE was approved in 2018 by the US Food and Drug Administration (FDA) for patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). As RLT has become integrated into clinical practice, understanding the presence of and management strategies associated with acute, subacute, or delayed toxicities is essential to optimize patient outcomes. In this review article, we consider the risk factors for complications and any preventative strategies that may be employed. We present an overview of the toxicities that could occur during or soon after RLT infusion and discuss recommended management strategies, both from the literature and from experience in the clinical administration of RLT for patients with GEP-NETs. We highlight the importance of robust procedures for handling emergency situations and the potential for radioactive contamination from patients' bodily fluids. Furthermore, the potential for delayed toxicities is also considered. In addition to toxicities and management, we also review the practical radiation safety precautions that are important both during and following RLT treatment.