Radioligand Therapy Side Effects and How to Manage Them

Common Side Effects

Radioligand therapy for prostate cancer is also called PSMA therapy because it targets prostate-specific membrane antigen (PSMA), a type of protein found in large amounts on the surface of up to 90 percent of prostate cancer cells. But PSMA is also found in smaller quantities on various other tissues in the body, such as the small intestines, liver, kidneys, and salivary glands. Most of the side effects from the treatment occur because the medication, lutetium Lu-177 vipivotide tetraxetan (Pluvicto), has attached to and damaged these normal tissues.

“Generally, this is a very well-tolerated treatment with limited side effects in most patients,” says Amir Iravani, MD, a nuclear medicine physician with UCLA in Los Angeles.

When side effects do occur, they can include the following.

Dry Mouth

Dry mouth is one of the most common side effects of PSMA therapy, affecting at least 4 in 10 patients. It occurs because the salivary glands are “a place where this medication also binds to and releases the radiation,” says Daniel Sentana, MD, a medical oncologist with the Dana-Farber Cancer Institute in Boston. Usually, the side effect is mild but in some cases it can make it difficult for people to eat and drink comfortably, he says.

Some recommended management strategies for dry mouth to keep your saliva flowing include:

Sodium bicarbonate (baking soda) mouthwash
Good hydration and regularly sipping water
Saliva gels or lubricants
Sugarless hard candies or gum
Dry mouth medications like pilocarpine

“This dry mouth tends to get better over time, but it’s not necessarily something that will,” Sentana says. “Once you start the treatment, it may take a long time to go away.”

Fatigue

Fatigue is about as common as dry mouth for people undergoing radioligand treatment for prostate cancer.

“Patients feel tired, especially in the next few days after treatment, and then it usually improves,” Dr. Iravani says, adding that the side effect is mild, and most prostate cancer patients already experience fatigue from other treatments like hormone therapy.

Get adequate rest, pace yourself during activities, engage in daily physical exercise, and lower your stress levels (such as through yoga and meditation) to manage your energy levels between and after treatments. If necessary, your provider may also prescribe stimulant medications like methylphenidate (Ritalin, Concerta) to combat fatigue.

Gastrointestinal Issues

Roughly a third of patients experience nausea from the treatment. Other gastrointestinal issues, including constipation, vomiting, diarrhea, and decreased appetite, are also common.

You may be given anti-nausea medication right before your infusion to help prevent nausea. If you do still experience nausea, it’ll typically happen on the day of or the day after treatment and can last a few more days, Iravani says. “It’s generally self-limiting, and it’s resolved by just taking over-the-counter or prescription anti-nausea medications,” he says.

To help with nausea and vomiting, you can also try eating smaller, more frequent meals consisting of room-temperature foods and drinks. Frequent meals, especially those high in calories and proteins, can also help with appetite issues, and you can try to make your food more palatable or tasty with sauces and spices.

Dietary fiber can relieve both constipation and diarrhea. Stick to insoluble fiber — found in beans, nuts, whole wheat, and vegetables like cauliflower, green beans, and potatoes — for constipation, and soluble fiber — found in apples, oats, bananas, carrots, and peas — for diarrhea. Antidiarrheal medications can also relieve loose stools.

Bone Pain

Talk with your healthcare provider if you experience bone pain, which may affect about 1 in 9 people undergoing PSMA therapy, typically during the first week after treatment. They may prescribe anti-inflammatory drugs like dexamethasone, opioids, or other pain relievers.

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Common Side Effects

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