Tumor lysis syndrome: A rare but serious complication of radioligand therapies

Radioligand therapy (RLT) is considered a safe treatment for patients with metastasized neuroendocrine tumors and prostate cancer, and the occurrence of tumor lysis syndrome (TLS) with ¹⁷⁷Lu-labeled peptides has not yet been reported. We retrospectively screened our patient database for TLS after RLT in neuroendocrine tumors and prostate cancer. Methods: The database was searched for patients receiving RLT with ¹⁷⁷Lu-DOTATATE, -DOTATOC, or -prostate-specific membrane antigen and showing laboratory or clinical abnormalities typical of TLS within 7 d after the start of treatment. Results: In total, 205 patients (539 cycles) were screened; 4 patients developed TLS with clinical symptoms and characteristic changes in laboratory parameters, which normalized after appropriate treatment. Follow-up revealed partial remission in 2 patients, a mixed response in one, and progressive disease in one. Conclusion: Clinical TLS is a rare but definite complication of RLT, suggesting that patient monitoring for TLS should be mandatory.