Outcome of 177Lu-PSMA Radionuclide Treatment in Advanced Prostate Cancer and Its Association With Clinical Parameters

Abstract

Purpose: This study was set out to analyze the efficacy and safety of 177 Lu-PSMA-617 (LuPSMA) treatment in metastatic castration-resistant prostate cancer (mCRPC) patients. Patients and Methods: Progressive mCRPC patients who received at least 1 cycle of LuPSMA therapy were evaluated retrospectively. Demographic, clinic, and histopathological data were documented. Treatment efficacy was determined based on biochemical response criteria (Prostate Cancer Clinical Trial Working Group 3), and toxicity rates were defined based on CTCAE v4.03. The prognostic significance of laboratory/clinical data and 68 Ga-PSMA PET/CT quantitative results were analyzed using SPSS Version 24.0. Results: One hundred patients (median prostate-specific antigen [PSA] level, 75.7 ng/mL) who met the eligibility criteria were identified. The median number of cycles received per patient was 3 (range, 1-9). After the first cycles of LuPSMA, biochemical partial response, biochemical stable disease, and biochemical progressive disease were observed in 31%, 36%, and 33% of patients, respectively. Any PSA decline was determined in 60% of patients. After the fourth cycle of treatment, biochemical partial response, biochemical stable disease, and biochemical progressive disease were defined in 48%, 26%, and 26% of patients, respectively. The median overall survival (OS) from the first cycle of LuPSMA was 14 months. Patients who had any PSA response after the first cycle had significantly longer OS than nonresponders (median OS: 17 vs 9 months; P ≤ 0.001). Total PSMA-derived tumor volume ( P = 0.004), total PSMA activity per lesion ( P = 0.01), PSA ( P = 0.007), alkaline phosphatase ( P = 0.002), lactate dehydrogenase ( P < 0.001), and hemoglobin ( P < 0.001) were significant prognostic factors for OS in univariate Cox regression analysis. Conclusions: LuPSMA therapy is a favorable treatment for mCRPC with remarkable therapeutic efficacy and low toxicity rates, even in progressive disease under standard therapies. Baseline PSMA-based tumor burden, PSA, alkaline phosphatase, lactate dehydrogenase, and hemoglobin were significant predictors of OS and can be useful for selection of the best candidate for LuPSMA therapy.

Prognostic role of early prostate specific antigen changes after [177Lu]Lu‐PSMA radioligand therapy of metastasized prostate cancer: A meta‐analysis

“…Other two studies did not report data about PSA changes after early [177Lu] Lu-PSMA cycles while a third article included a sample <30 patients, respectively. Finally, nine studies from databases and three from citation searching were included in our present study 28,32,34,35,[42][43][44][45][46][47][48][49] for a total of 1646 patients. Characteristics of included studies are reported in Table 1.…”

“…The most recent study started in 2016 and were completed within 2020. Six studies assessed PSA changes through PCWG3 criteria 28,32,35,44,45,47 . Among six remaining studies, five assessed PSA considering any PSA decline, PSA decline ≥50% and PSA increase comparing post‐RLT to baseline PSA values, respectively 34,42,43,46,48 while one study considered any PSA change (decrease or increase) of at least 25% of the baseline value 49 .…”

“…Six studies assessed PSA changes through PCWG3 criteria. 28,32,35,44,45,47 Among six remaining studies, five assessed PSA considering any PSA decline, PSA decline ≥50% and PSA increase comparing post-RLT to baseline PSA values, respectively 34,42,43,46,48 while one study considered any PSA change (decrease or increase) of at least 25% of the baseline value. 49 The studies reported a total of 177Lu-PSMA cycles ranging from 164 32 to 1493, 42 with a median of 3 cycles for patients.…”

177Lu-PSMA-617 Therapy in a Case of Metastatic Castration-Resistant Prostate Cancer

“…177 Lu-PSMA-617 has prolonged imaging-based progression-free survival and overall survival in mCRPC (metastatic castration-resistant prostate cancer) with a low incidence of acute adverse effects. [1][2][3][4][5] However, a complete metabolic response (PERCIST 1.0) upon imaging with disappearance of pain is uncommon. [6][7][8] This case suggests that 177 Lu-PSMA-617 treatment is an effective and reliable treatment option to relieve the pain in and delay the progression of mCRPC.…”

Exceptional Response of Rare Plasmacytoid Variant Prostate Cancer Post 177Lu-PSMA Therapy Seen on 68Ga-PSMA PET/CT

“… A – D , 177 Lu-PSMA therapy is gaining momentum in achieving desirable results with minimal adverse effects in mCRPC 5–8 . The patient was referred for 4 cycles 177 Lu-PSMA therapy.…”