How Bex Works
What does Bexlutry bind to which are found in many GEP NET cells and delivers targeted radiation to?
Somatostatin receptors (SSTRs)
T or F
Decrease the dose of Amino Acid solution if the dose of Bexlutry is reduced
False
What two drugs interact with Bexlutry?
Somatostatin Analogs
Glucocorticoids
What guidelines include Lutetium 177 Dotatate as 1st line therapy with well differentiated GEP NETs?
NCCN Guidelines
Name 3 of the 5 conditions why a Bexlutry dose should be modified?
Hematologic
Renal
Hepatic
Hypersensitivity
Other adverse reactions
Name two of the Grade 3-4 adverse reactions?
lymphopenia, increased GGT, vomiting, nausea, increased AST, increased ALT, hyperglycemia and hypokalemia.
What is recommended as the first step to administer prior to the Bexlutry infusion?
Anti-Nausea Medication (antiemetics)
Daily DOUBLE
What is the half-life of Bexlutry?
6.6 days
Bonus 100 points - How long would it need to be stored?
Bonus 100 points - What is the half-life of Lu-177m
Bonus 100 points - How long would Lu-177m need to be stored?
What is the chelator and ligand in Bexlutry?
Dota - Tate
What are the 2 amino acids needed for an infusion?
Bonus: Is there any concern about using the commercially available amino acids solutions?
L-lysine
L_arginine
Bonus: Possibly, because the commercially available solutions have more than these two amino acids, which could cause excess nausea. Consider specialty compounding as an option.
What dose modifications should be made, if any, for patients with baseline mild to moderate renal impairment?
What are other considerations?
Bonus: What about baseline severe renal impairment cases?
None
Patients may be at greater risk for renal toxicity due to increased radiation exposure, more frequent assessment of renal function in these patients is recommended.
Bonus: Baseline severe renal impairment cases has not been studied.
Daily Double
What is the Reduction in Risk of Progression or Death in Netter-1?
79%
Bonus: What is the Reduction in Risk of Progression or Death in Netter-2?
Describe the administration times for the entire Bexlutry administration (including anti-nausea meds and amino acid infusions).
"30-30-30-3"
30 minutes - first 30 mins is anti-nausea meds
30 minutes - second 30 mins start amino acid infusion (before administering Bexlutry).
30 minutes - third 30 mins (up to 40 mins) Bexlutry infusion, continue AA.
3 hours - post Bexlutry infusion, continue AA infusion
How is Bexlutry eliminated and what is the amount of excretion within 5 hours and within 14 days of administration?
Bonus: Describe changes in the mean QTC interval and the hepatic metabolism of Bexlutry.
Renally
Cumulative excretion of 44% within 5 hours and 99% within 14 days after administration of lutetium Lu 177 dotatate injection.
Bonus: There were no large changes in the mean QTC interval, and it does not undergo hepatic metabolism