Theranostic Treatments and Preparation

Xofigo is used to treat prostate cancer that no longer responds to hormonal or surgical treatment that lowers testosterone. It is for men whose prostate cancer has spread to the bone with symptoms but not to other parts of the body.

Before each treatment:

• Blood cell count monitoring is very important while on Xofigo. You will get a blood test so your doctor can ensure your blood counts are normal and it is okay for you to receive your injection.

On your day of treatment:

• You will receive a 2-minute injection in the vein every 4 weeks, for a total of 6 injections.

After each treatment:

• Once the injection is finished, you can leave the office and go about your daily activities
• There are no restrictions regarding personal contact (visual or physical proximity) with other people
• Drink enough fluids after each treatment. Tell your doctor is you become dehydrated or experience urinary or kidney problems
• Bathroom hygiene is important! While being treated with Xofigo – until 1 week after the last injection – you should:
  • Wash your hands well every time you go to the bathroom
  • Flush the toilet several times after each use
  • Make sure that if bodily waste is spilled, it is removed completely and quickly. If bodily waste gets on clothing, was it right away by itself. Afterward, you should wash your hands very well. Anyone who helps you should wash their hands well, too
  • Wear one-use gloves or gowns anytime you clean up bodily waste. Dispone of gloves or gowns as directed by your health care provider
  • Keep your bathroom area clean
• You can have sexual relations while being treated with Xofigo. Because of the possible effect that radiation can have on sperm, you should always wear a condom. Also, your female partners should use effective contraception during your treatment and for 6 months after treatment is over.
• Your nuclear medicine doctor will inform you if you need to take any special precautions after receiving this medication.

Pluvicto treats patients with prostate-specific membrane antigen-positive metastatic castration-resistant prostate cancer (PSMA-positive mCRPC) that has spread to other parts of the body (metastatic) and has already been treated with other anticancer treatments.

Before treatment:

• Drink plenty of water

During treatment:

• You will be kept at a distance from other patients
• Drink plenty of fluids and urinate as frequently as possible to eliminate the product from your body

After treatment:

• Remain hydrated and urinate frequently to eliminate the product from your body
• Limit close contact (less than 3 feet) with other people in your household for 2 days or with children and pregnant women for 7 days
• Refrain form sexual activity for 7 days
• Sleep in separate bedroom from household contacts for 3 days, from children for 7 days or from pregnant women for 15 days
• Shower daily for 7 days
• Use the bathroom carefully:
  • Use a separate bathroom if possible, or wipe it down after you use it
  • For 2 days, always sit while using the toilet; use and flush toilet paper every time
  • For 3 days, whenever anyone helps you in the bathroom, they should always wear disposable gloves
• During your course of treatment, wash your laundry separately from others
• No sex for 7 days; during your course of treatment, use effective contraception during treatment for 14 weeks after the final dose
• Contact your health care provider is you experience low level of blood cell counts or have kidney problems
• Plan your next bloodwork appointment with your health care provider 1-2 weeks before your next treatment
• Your nuclear medicine doctor will inform you if you need to take any special precautions after receiving this medication. This may include precautions for you and your caregiver regarding toilet use, showering, laundry, waste disposal, emergency medical assistance, unplanned hospitalization or traveling

Lutathera is a treatment for those with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). GEP-NETs are tumors of the neuroendocrine cells from the stomach, gut or pancreas that make hormones.

Before treatment

• Tell your health care provider about your disease and health status, including if you are taking somatostatin analog (SSA). If you are taking SSAs, you may have to stop or change your treatment before and while taking Lutathera.
• Before your first treatment, you will need a baseline PET/CT dotatate study so your provider can localize the tumor. You may also need blood work and other tests to ensure your kidneys, liver and blood counts are within an acceptable range for treatment and that it’s safe for you to receive your injection.

The Infusion

Lutathera is given as an intravenous (IV) injection every 8 weeks for a total of 4 doses. The infusion lasts about 4 hours.

30 minutes before you are given Lutathera you will receive an amino acids infusion via IV. This will help protect your kidneys and minimize potential side effects. The infusion will take 4 hours and will continue during and after you receive Lutathera.

The Lutathera infusion will take approximately 30 mins.

After each dose

• Because Lutathera treatment uses radiation, you will have to wait a short while before you can leave. Your nuclear medicine doctor will provide further instructions to help minimize radiation exposure to others.
• Stay well hydrated and urinate frequently during the first 3 days. The more you urinate, the faster the radiation will leave your body.
• Within a day of receiving Lutathera, you will be given an injection of long-acting octreotide 30 mg. You will receive this after each treatment dose. This is arranged with your referring oncologist.
• Between each dose and after your last treatment, your health care provider may run tests to check your liver, kidneys and blood.
• Report any side effects to your provider such as vomiting, nausea and or increased blood glucose levels.
• Follow good hygiene practices and safety protocols to minimize radiation exposure from spills of bodily fluids to household members and caregivers for 1 week after each injection.