¹⁷⁷Lu-PSMA Therapy

Abstract

CE credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than September 2025. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 75% of the questions correctly to receive Continuing Education Hour (CEH) credit. Credit amounts can be found in the SNMMI Learning Center Activity. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test.Radiopharmaceutical therapy using 177 Lu-prostate-specific membrane antigen (PSMA) is an effective prostate cancer treatment that was recently approved by the U.S. Food and Drug Administration. This method leverages the success of PSMAtargeted PET imaging, enabling delivery of targeted radiopharmaceutical therapy; has demonstrated a clear benefit in large prospective clinical trials; and promises to become part of the standard armamentarium of treatment for patients with prostate cancer. This review highlights the evidence supporting the use of this agent, along with important areas under investigation. Practical information on technology aspects, dose administration, nursing, and the role of the treating physician is highlighted. Overall, 177 Lu-PSMA treatment requires close collaboration among referring physicians, nuclear medicine technologists, radiopharmacists, and nurses to streamline patient care.

Logistical, technical, and radiation safety aspects of establishing a radiopharmaceutical therapy program: A case in Lutetium‐177 prostate‐specific membrane antigen (PSMA) therapy

“…Recent articles have summarized aspects of Lu‐177 PSMA therapy. 9 , 10 , 12 Here, we describe the logistical, technical, and radiation safety considerations for implementing a RPT program, with particular focus on the development of operating procedures for therapeutic administrations. An outline of major tasks for a center in the U.S. to implement a new RPT program is shown below, and each task is then demonstrated in greater detail via examples for Lu‐177‐PSMA‐617 therapy.…”

“…[2][3][4][5] Biologic clearance of the non-tumor bound radioligand is via the kidneys and is mostly complete by 48 h. 3,5 Multiple randomized trials of targeted radionuclide therapy using Lu-177-PSMA-617 have reported positive results in patients with metastatic castration-resistant prostate cancer (mCRPC), most notably the VISION trial for patients treated with androgen receptor pathway inhibition and taxane-based chemotherapy, [6][7][8] with more prospective clinical trials evaluating Lu-177-PSMA-617 and other PSMA-targeted ligands for other patient populations, including pre-taxane and hormone-sensitive patients, underway. 9,10 In March of 2022, based on the results of the VISION trial, the FDA (Food and Drug Administration) granted approval of the use of Lu-177-PSMA-617 for patients with mCRPC who test positive for PSMA with an FDA-approved imaging diagnostic agent and have been treated with androgen receptor pathway inhibition and taxane-based chemotherapy. 11 Therefore, the use of Lu-177-PSMA-617 is expected to increase and become more widespread.…”

“…Therefore, the use of Lu‐177‐PSMA‐617 is expected to increase and become more widespread. Recent articles have summarized aspects of Lu‐177 PSMA therapy 9,10,12 . Here, we describe the logistical, technical, and radiation safety considerations for implementing a RPT program, with particular focus on the development of operating procedures for therapeutic administrations.…”

Threshold for defining PSMA-positivity prior to 177Lu-PSMA therapy: a comparison of [68Ga]Ga-PSMA-11 and [18F]F-DCFPyL in metastatic prostate cancer

“…Radioligand therapy with 177 Lu-labelled PSMA ligands has been used successfully for several years as part of individualised treatment plans for patients with prostate cancer [ 10 ]. In 2022, based on the PSMA-VISION trial, [ 177 Lu]Lu-PSMA-617 (PLUVICTO™, Novartis AG, Basel, Switzerland) became the first PSMA-directed radiopharmaceutical to be formally approved by the American Food and Drug Administration and the European Medicines Agency for the treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer who had previously been treated with androgen receptor pathway-inhibiting drugs and taxane-based chemotherapy [ 11 , 12 ].…”

“…Although PSMA overexpression is a common finding in patients with prostate cancer, there is a considerable intra- and interpatient heterogeneity [ 13 , 14 ]. Appropriate patients should therefore be identified by PSMA-PET prior to radioligand therapy according to the principles of theranostics [ 3 , 4 , 10 ]. In the PSMA-VISION trial, patients were required to have PSMA-positive tumour lesions, defined as PSMA expression above the liver background on PET using [ 68 Ga]Ga-PSMA-11 [ 3 ].…”