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Therapy of Neuroendocrine Tumors

Zurich University Hospital (USZ) is a certified center for t he treatment of Neuroendocrine tumors. The European Society for Neuroendocringe Tumors (ENETS) has designed USZ as the only Swiss center with the “excellency status”. All patiens who are presente to us for diagnosis or therapy, are discussed at our ENETS tumor board. All referring physicians are cordially invited to partake in that board.

Overview

In addition to many possible therapies, USZ offers the radiopeptide therapy with Lutethium-177-DOTATATE. This therapy is similar to Octreotide or Lanreatide with the compound binding to Somatostatin receptor 2 in order to irradiate the tumor cells locally. The therapy is usally applied over four cycles every 8 weeks. The patient is seen once by the oncologist between the cycles and after the end of therapy, the patient is referred back to his physician.

Risks

The risk for untoward reactions during this type of radiation therapy iss mall. Most patients do not feel any restrictions as a result. The radioactive element Lutetium-177 irradiates only tissue in within 4 mm of its presence. As it fixes in the tumor, little normal surrounding tissue is irradiated alongside.

Procedure of therapy

Lutetium-177 DOTATATE is partly taken up by the kidney very much like amino acids. In order to avoid renal damage, the kidneys have to be blocked for the DOTATATE compound. This is done by intravenously applying a solution of amino acids. The infusion is usually tolerated without side effects and is not harmful to the kidneys. Nevertheless there is a small risk of kidney damage by Lutetium-177 DOTATATE. In very rare cases this can lead all the way to a dependence on renal dialysis. Studies have shown that this happens in less than half a percent of patients and most of these patients suffered from pre-existing renal disease.

While injecting DOTATATE, patients may experience some nausea and vomiting of short duration (5 min) and this occurs in approximately 5% of patients. The ensuing stay for therapy is usually tolerated without other untoward effects. During therapy 30% of patients exhibit a slight decrease in white blood cells, but the recovery occurs in just a few weeks.

Indications for Lutetium-177 DOTATATE-Therapy

General indication

  • According to ENETS guidelines (e.g. second line MIDGUT tumors after Sandostatin), Inoperable disease, ECOG 0 – 2

Contra-Indication

  • Pregancy or breast feeding
  • Medium to severe renal insufficiency (clearence 40 – 50ml/min)
  • Severe liver disfunction (Bilirubin > 100 mg/dl)
  • Severe liver disfunction
  • Severe medical disease in general (e. g. COPD Gold IV)
  • Dominant extrahepatic disease

Responsible doctors

Ivette Engel-Bicik, Dr. med.

Senior Attending Physician, Department of Nuclear Medicine
Nuclear Medicine Physician, Department of Nuclear Medicine

Specialties: Thyroid and parathyroid diagnostics and therapy, Theranostics
Tel. +41 44 255 35 55

Ralph Fritsch, Dr. med.

Head of Colorectal Cancer Center, Comprehensive Cancer Center Zurich
Head of Endocrine and Neuroendocrine Tumor Centre, Comprehensive Cancer Center Zurich
Head of Liver and Pancreas Tumor Center, Comprehensive Cancer Center Zurich
Head of the Gastro- and Oesophageal Tumor Centre, Comprehensive Cancer Center Zurich

Specialties: Gastrointestinal tumours, hepatobiliary tumours, molecular oncology and precision oncology
Tel. +41 43 253 93 05

For patients

As a patient, you cannot register directly for a consultation. Please have your family doctor, specialist refer you. If you have any questions, please use our contact form.

Tel. +41 44 255 35 55

For referring physicians

Simply assign your patient via registration form.

Tel. +41 44 255 35 55

Medical information hotline: 08.00-18.00 o’clock: +41 44 255 15 01