What is peptide therapy?

Peptide therapy is a form of radionuclide therapy. It works by attaching a radioactive substance (or radioisotope) to a peptide. Peptides naturally exist in the body and are made of amino acids. There are many types of peptides and each peptide has a specific binding mechanism. Similarly, a cell type will have a receptor that also has a specific binding mechanism. A peptide can only bind with a specific type of receptor. An example of this is glucagon, a peptide hormone. Its function is to cause the liver to produce glucose. It does this by binding to specific receptors in the liver.

A cancerous neuroendocrine tumour has specific receptors. A peptide, DOTATATE, binds to some of these receptors. This is utilised by attaching the radioisotope lutetium to this peptide. This is what we call lutetium-DOTATATE. The peptide then ‘seeks-out’ the cancerous neuroendocrine tumours and the attached radioisotope delivers a high, localised radiation dose to the diseased cells. In parallel to the administration of the lutetium-DOTATATE, amino acids are given in order to protect the kidneys from unnecessary radiation.

The treatment is carried out as a day-admission in The London Clinic’s Duchess of Devonshire wing. The lutetium-DOTATATE and amino acids are delivered through a drip into a vein in the arm. The treatment is cyclic, often four treatments carries out in three month intervals. The treatment is carried out by an experience nuclear medicine clinician and a medical physicist is present to give radiation protection advice for both during the treatment and following discharge.

While an in-patient, the patient is limited to the room for the day. Visitors are allowed but are requested to follow the advice of the medical physics team. Typically this involves limited contact with the patient, and the wearing of personal protective equipment such as disposable gowns and gloves.

Typical precautions following discharge include avoiding close (less than arm’s length) and prolonged (greater than 10 minutes) contact with:

  • Children under six for seven days
  • Pregnant women for seven days
  • Adults in regular interaction (i.e. close friends and family members) including sharing a bed for two days

These precautions can typically be introduced into a daily routine without much hindrance. A medical physicist can discuss typical precautions prior to treatment.

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