text: Lutathera is a peptide receptor radioligand/radionuclide therapy (approved by the FDA in 2018) specifically for patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) that have somatostatin hormone receptors (SSTR). The radioisotope is Lu-177 and the ligand is a SSTR on the surface of tumor cells. 
  Lu-177 is produced by bombarding the stable isotope Yb-176 (which is found in monazite sand as well as the ores euxenite and xenotime) with neutrons. Yb-176 turns into Yb-177 which is unstable and has a half life of 1.9 hours so it quickly decays into the medical isotope Lu-177. For mass production, it is better to produce Yb-176 through fission reactors. This is the indirect production method and requires elaborate radiochemical separation, purification, and results in large amounts of radioactive waste. The direct method of producing Lu-177 is by performing neutron irradiation on Lu-176 to Lu-177. This is an inexpensive and effective method to produce Lu-177. In the United States, the main place that Lu-177 is produced is the University of Missouri Research Reactor.
  Once produced, Lu-177 is stable for 72 hours if stored below room temperature. Freeze dried kits of Lutathera do show reduced effectiveness in radiation therapy but they maintain radiochemical purity. Lu-177 requires radiation shielding for handling. Lu-177 is stored and transported in a vial with lead/plexiglass shielding ready-to-use. Repeated production, timely delivery, and quick administration are important so that the therapy remains effective.
  Once transported to the hospital or cancer treatment / oncology center, the patient is prepped, all necessary tests are done, and the patient requires two separate IV sites for infusion. One site for radioactive Lu-177 infusion and one site for amino acid infusion. Amino acid infusion is needed to reduce radiation toxicity to the organs - specifically the kidneys. The sites are separate to prevent radioactive contamination after therapy. The patient receives therapy by automated syringe, infusion pump, or gravity using long/short needles, tubing, and sodium chloride solution. Antiemetic (anti-nausea) medications or short/long acting octreotide (cancer growth control) can be used post-therapy for symptom management.
  The most common side effects include decreased blood cell counts, increased liver enzymes, vomiting, nausea, increased blood glucose, and decreased blood potassium levels. Lutathera is not given to pregnant or breastfeeding individuals. The therapy shrinks tumors by an average of 30%, reduces disease progression by 72%, and delays the growth of tumors.