Overall survival and response pattern of castration-resistant metastatic prostate cancer to multiple cycles of radioligand therapy using [177Lu]Lu-PSMA-617

Ahmadzadehfar, Hojjat; Wegen, Simone; Yordanova, Anna; Fimmers, Rolf; Kürpig, Stefan; Eppard, Elisabeth; Wei, Xiao X.; Schlenkhoff, Carl Diedrich; Hauser, Stefan; Essler, Markus

doi:10.1007/s00259-017-3716-2

Cited by 149 publications

(139 citation statements)

References 23 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…Thus, in accordance with Rahbar et al and results of the current study, the cumulative administered activity of PSMA‐RLT also seemed to correlate positively with survival. Similarly, other reports have suggested that all PSA decreases are reliable markers for predicting response and survival following PSMA‐RLT …”

Section: Discussionmentioning

confidence: 61%

“…The radiolabeling, administration, and treatment procedures in this study were conducted using previously described methods . The median administered activity per cycle was 6.2 GBq (total range of 3.2‐7.5 GBq).…”

Section: Methodsmentioning

confidence: 99%

“…However, PSMA‐RLT is still considered a last‐line treatment option, as data from prospective randomized phase III trials are lacking . According to recent studies, PSMA‐RLT seems to be safe and effective, even for patients with advanced PC or multiple PC relapses following several therapies . In the literature, the typical length of time that patients live posttreatment ranges between 7.5 and 15 months …”

Section: Introductionmentioning

confidence: 99%

“…Various biochemical markers have been assessed to determine the predictive value of responses and overall survival (OS) following PSMA‐RLT . We previously reported that the most important predictive tumor marker for response and survival post‐PSMA‐RLT is prostate‐specific antigen (PSA).…”

Section: Introductionmentioning

confidence: 99%

“…16,17 According to recent studies, PSMA-RLT seems to be safe and effective, even for patients with advanced PC or multiple PC relapses following several therapies. 15,[18][19][20][21][22][23][24][25][26][27] In the literature, the typical length of time that patients live posttreatment ranges between 7.5 and 15 months. 18,22,25,28,29 Various biochemical markers have been assessed to determine the predictive value of responses and overall survival (OS) following PSMA-RLT.…”

mentioning

confidence: 99%

See 4 more Smart Citations

The value of tumor markers in men with metastatic prostate cancer undergoing [¹⁷⁷Lu]Lu‐PSMA therapy

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background Currently, prostate‐specific membrane antigen‐radioligand therapy (PSMA‐RLT) is considered a last‐line treatment option in advanced castration‐resistant prostate cancer. Despite these patients' poor prognosis, accurate estimation of their overall survival (OS) is essential to determine whether benefits exist from the treatment and whether the loss of valuable time and unnecessary side effects can be avoided. The aim of the present study is to evaluate whether various biochemical markers can predict OS in men undergoing PSMA‐RLT and whether the changes assessed after PSMA‐RLT correlate with the OS. Methods The tested tumor markers in this retrospective analysis were alkaline phosphatase (ALP), bone‐specific alkaline phosphatase (BAP), prostate‐specific antigen (PSA), lactate dehydrogenase (LDH), chromogranin A, and pro‐gastrin‐releasing peptide (pro‐GRP). For the evaluation, we performed blood tests before each PSMA‐RLT cycle and during follow‐up visits (which were 2‐3 months apart). All patients were followed up until their deaths. To test the correlations between the tumor markers and survival, we conducted the logrank tests and the multivariate Cox proportional‐hazards regression model. The significance level was set at P < .05. Results The study included 137 patients who received a total of 487 PSMA‐RLT cycles between January 2015 and November 2017. Of the tested biochemical tumor markers, baseline ALP (120 U/L cut‐off), LDH (248 U/L cut‐off), and PSA (first quartile cut‐off) correlated significantly with survival post‐PSMA‐RLT (P < .001 for ALP and LDH, and P = .007 for PSA). Stable and/or decreased values in most of the initially abnormal parameters were associated with significantly better OS; these parameters were ALP (P = .009), LDH (P = .005), PSA (P < .001), and pro‐GRP (P = .013). The BAP and ALP responses also correlated significantly with survival in patients with bone metastases (P = .002 and P < .001, respectively). Furthermore, there was a strong correlation of the kinetic patterns of PSA, ALP, BAP, and LDH with the survival, showing that patients with steadily increasing markers had the shortest OS. Conclusion Along with the established tumor marker PSA, ALP, LDH, BAP, and pro‐GRP were correlated with the OS post‐PSMA‐RLT in the univariate and multivariate analyses.

show abstract

Section: Discussionmentioning

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

The value of tumor markers in men with metastatic prostate cancer undergoing [¹⁷⁷Lu]Lu‐PSMA therapy

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

¹⁷⁷Lu‐PSMA radioligand therapy effectiveness in metastatic castration‐resistant prostate cancer: An updated systematic review and meta‐analysis

et al. 2022

View full text Add to dashboard Cite

Background An updated systematic review and meta‐analysis of relevant studies to evaluate the effectiveness of prostate‐specific membrane antigen (PSMA)‐targeted endoradiotherapy/radioligand therapy (PRLT) in castration resistant prostate cancer (CRPC). Methods A systematic search was performed in July 2020 using PubMed/Medline database to update our prior systematic review. The search was limited to papers published from 2019 to June 2020. A total of 472 papers were reviewed. The studied parameters included pooled proportion of patients showing any or ≥50% prostate‐specific antigen (PSA) decline after PRLT. Survival effects of PRLT were assessed based on pooled hazard ratios (HRs) of the overall survival (OS) according to any PSA as well as ≥50% PSA decline after PRLT. Response to therapy based on ≥50% PSA decrease after PRLT versus controls was evaluated using Mantel‐Haenszel random effect meta‐analysis. All p values < 0.05 were considered as statistically significant. Results A total of 45 publications were added to the prior 24 studies. 69 papers with total of 4157 patients were included for meta‐analysis. Meta‐analysis of the two recent randomized controlled trials showed that patients treated with 177Lu‐PSMA 617 had a significantly higher response to therapy compared to controls based on ≥50% PSA decrease. Meta‐analysis of the HRs of OS according to any PSA decline and ≥50% PSA decline showed survival prolongation after PRLT. Conclusions PRLT results in higher proportion of patients responding to therapy based on ≥50% PSA decline compared to controls. Any PSA decline and ≥50% PSA decline showed survival prolongation after PRLT. Advances in knowledge: This is the first meta‐analysis to aggregate the recent randomized controlled trials of PRLT which shows CRPC patients had a higher response to therapy after PRLT compared to controls.

show abstract

Any decline in prostate‐specific antigen levels identifies survivors scheduled for prostate‐specific membrane antigen‐directed radioligand therapy

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Prostate‐specific membrane antigen (PSMA)‐targeted radioligand therapy (RLT) is increasingly incorporated in the therapeutic algorithm of patients with metastatic castration‐resistant prostate cancer (mCRPC). We aimed to elucidate the predictive performance of early biochemical response for overall survival (OS). Materials and Methods In this bicentric analysis, we included 184 mCRPC patients treated with 177Lu‐PSMA RLT. Response to treatment was defined as decrease in prostate‐specific antigen (PSA) levels 8 weeks after the first cycle of RLT (any decline or >50% according to Prostate Cancer Working Group 3). OS of responders and nonresponders was then compared using Kaplan–Meier curves and log‐rank comparison. Results A total of 114/184 patients (62.0%) showed any PSA decline (PSA response >50%, 55/184 [29.9%]). For individuals exhibiting a PSA decline >50%, OS of 19 months was significantly longer relative to nonresponders (13 months; hazard ratio of death [HR] = 0.64, 95% confidence interval [95% CI] = 0.44–0.93; p = 0.02). However, the difference was even more pronounced for any PSA decline, with an OS of 19 months in responders, but only 8 months in nonresponders (HR = 0.39, 95% CI = 0.25–0.60; p < 0.001). Conclusions In mCRPC patients scheduled for RLT, early biochemical response was tightly linked to prolonged survival, irrespective of the magnitude of PSA decline. As such, even in patients with PSA decrease of less than 50%, RLT should be continued.

show abstract

Overall survival and response pattern of castration-resistant metastatic prostate cancer to multiple cycles of radioligand therapy using [177Lu]Lu-PSMA-617

Abstract: Patients with a positive response to RLT, regardless of the rate of decline, had a significantly longer median OS. Of the patients that did not show any response to the first cycle, 50% responded to the second or third cycles.

Cited by 149 publications

References 23 publications

The value of tumor markers in men with metastatic prostate cancer undergoing [¹⁷⁷Lu]Lu‐PSMA therapy

The value of tumor markers in men with metastatic prostate cancer undergoing [¹⁷⁷Lu]Lu‐PSMA therapy

¹⁷⁷Lu‐PSMA radioligand therapy effectiveness in metastatic castration‐resistant prostate cancer: An updated systematic review and meta‐analysis

Any decline in prostate‐specific antigen levels identifies survivors scheduled for prostate‐specific membrane antigen‐directed radioligand therapy

Contact Info

Product

Resources

About

Overall survival and response pattern of castration-resistant metastatic prostate cancer to multiple cycles of radioligand therapy using [177Lu]Lu-PSMA-617

Abstract: Patients with a positive response to RLT, regardless of the rate of decline, had a significantly longer median OS. Of the patients that did not show any response to the first cycle, 50% responded to the second or third cycles.

Cited by 149 publications

References 23 publications

The value of tumor markers in men with metastatic prostate cancer undergoing [177Lu]Lu‐PSMA therapy

The value of tumor markers in men with metastatic prostate cancer undergoing [177Lu]Lu‐PSMA therapy

177Lu‐PSMA radioligand therapy effectiveness in metastatic castration‐resistant prostate cancer: An updated systematic review and meta‐analysis

Any decline in prostate‐specific antigen levels identifies survivors scheduled for prostate‐specific membrane antigen‐directed radioligand therapy

Contact Info

Product

Resources

About

The value of tumor markers in men with metastatic prostate cancer undergoing [¹⁷⁷Lu]Lu‐PSMA therapy

The value of tumor markers in men with metastatic prostate cancer undergoing [¹⁷⁷Lu]Lu‐PSMA therapy

¹⁷⁷Lu‐PSMA radioligand therapy effectiveness in metastatic castration‐resistant prostate cancer: An updated systematic review and meta‐analysis