Excellent Response to Adapted Low-Dose 177Lu-PSMA-617 PSMA Therapy in Renal Compromise Patient

Abstract

Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy with 177 Lu-PSMA-617 has shown promising results in patients with metastasized castration-resistant prostate cancer. We report a case of a 74-yearold man with metastatic prostate cancer with comorbidities of diabetes mellitus, hypertension, and chronic kidney disease. In order to minimize radiation burden to kidneys, a lower dose of 4 GBq of 177 Lu-PSMA-617 was prescribed instead of the usual 6 to 7 GBq. There was significant decrease in prostate-specific antigen levels and symptoms. Renal profile remained stable. This case highlights that compromised renal function is not a definite contraindication to radionuclide therapy, and doses can be modified based on risk versus benefits.

Excellent Response to Full-Dose 177Lu-PSMA-617 RLT in Metastatic Castration-Resistant Prostate Cancer With Transplant Kidney

“…[2][3][4][5][6] The mCRPC patients with transplant kidney or end-stage renal disease receive lower than full dose of 177 Lu-PSMA, thereby preventing optimum therapeutic effect. 7,8 There is a dearth of literature for use of RLT in mCRPC patients with transplant kidney. This case report shows the efficacy of full dose of 177 Lu-PSMA RLT as an alternate option to nephrotoxic chemotherapy in mCRPC patients with renal transplant.…”

“…177 Lu-PSMA is safe in mCRPC patients with impaired renal function and single functioning kidney with only a slight (~1%) risk of radiation-induced nephropathy 2–6 . The mCRPC patients with transplant kidney or end-stage renal disease receive lower than full dose of 177 Lu-PSMA, thereby preventing optimum therapeutic effect 7,8 . There is a dearth of literature for use of RLT in mCRPC patients with transplant kidney.…”