Radiopharmaceuticals Pack a One-Two Punch Against Cancer

April 27, 2021

Radionuclides, also called radioisotopes, are unstable chemical elements that release radiation as they break down, and that action can be combined with cancer drugs to fight tumors with a new punch. During a session on April 27, 2021, for the 46th Annual ONS Congress, Pam Grubbs, APRN, CNS, MS, AOCNS®, of Mayo Clinic in Rochester, MN, discussed how oncology is using radiopharmaceuticals in a variety of ways.

Current Radionuclide Treatments and Indications

Grubbs reviewed key nursing considerations for each radionuclide currently approved for treatment of cancer.

Radium 223 is an injection for castration-resistant prostate cancer that has spread to bone. It mimics calcium and forms complexes with bone minerals in those metastases, and the radiation effect as it decays and causes an antitumor effect, she explained. Nurses should monitor blood cell counts throughout treatment and watch for nausea, diarrhea, vomiting, and swelling in the legs and feet. Caution patients with partners of reproductive potential to use effective birth control during treatment.

Yttrium Y-90 is given as an outpatient procedure by injecting microspheres via an arterial catheter that emit pure beta radiation into liver tissues to treat unresectable hepatocellular carcinoma, metastatic liver cancer, and cholangiocarcinoma. Side effects are dose-dependent, Grubbs said, and may include abdominal pain, nausea, and vomiting. Monitor liver function tests after injection.

Yttrium-90 ibritumomab tiuxetan is an IV infusion used in combination with rituximab to treat low-grade or follicular B-cell non-Hodgkin lymphoma (NHL) that is CD20-positive and has relapsed during or after treatment with other anticancer drugs. It’s an antibody treatment that binds to CD20-positive malignant B cells. It also is indicated in newly diagnosed follicular NHL following a response to initial anticancer therapy. Patient education involves discussion of the infusion schedule, the importance of monitoring platelet counts, and the need to be careful with patient waste (for example, sitting to void, wiping up any spills), but patients do not need to stay distanced from others. Nurses should be aware of the possibility of extravasation, Grubbs said.

Radioiodine l-131 is the gold-standard treatment for thyroid cancer. It can be delivered via an oral solution or pill, usually in the inpatient setting, dependent on dose. Safety considerations include:

Lutetium lu 177 dotatate is an IV infusion for refractory neuroendocrine tumors that targets somatostatin receptors on cancer cells. Patients are premedicated with antiemetics and amino acids, and female patients must have a negative pregnancy test. Safety precautions are similar to radioiodine l-131.

Nurses’ Role in Implementing Radiopharmaceutical Programs

Sharing her own experience in developing a radiopharmaceutical program, Grubbs suggested that nurse leaders:

“Communication and knowledge-sharing are essential. We had talks and meetings for a year prior to implementation,” Grubbs said. “Take an interprofessional approach. Make diagrams of the patient journey to include everyone who will touch the patient. Involve everyone in all aspects of planning, and make patient education available at every step.”

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