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

## TL;DR

This paper reviews how to manage side effects and radiation safety for patients with GEP-NETs undergoing radioligand therapy.

## Contribution

The paper provides practical strategies for managing toxicities and ensuring radiation safety in RLT for GEP-NETs.

## Key findings

- Radioligand therapy can cause acute, subacute, and delayed toxicities in GEP-NET patients.
- Proper management strategies and radiation safety protocols are essential for optimizing patient outcomes.
- Emergency procedures and contamination prevention are critical during and after RLT treatment.

## Abstract

Radioligand therapy is a type of treatment being developed for many cancer types, including gastroenteropancreatic neuroendocrine tumors (GEP-NETs). It uses specially designed drugs to deliver radiation directly to tumor cells within the body. Studies have shown that radioligand therapies can help some patients with GEP-NETs to live longer without disease progression. However, side effects have been reported in patients treated with radioligand therapies. Additionally, there is a risk of radiation exposure among people who come into contact with treated patients. In this article, we provide practical strategies to prevent and manage the side effects of radioligand therapy and to maintain radiation safety.

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.