Treatment outcome and identification of factors influencing overall survival after Lu-177-PSMA-617 radioligand therapy in metastatic prostate cancer.

Abstract

OBJECTIVE:

To examine the clinical benefit of Lu-177-PSMA-617 radioligand therapy for patients with metastatic castration-resistant prostate cancer (mCRPC).

PATIENTS AND METHODS:

Between November 2014 and December 2018, a total of 56 consecutive patients (median age 69.5 years; range 55-84 years) with mCRPC were included in this retrospective analysis. Patients received between 1 and 4 therapy cycles with a mean activity of 6.8 GBq per cycle. Biochemical response was evaluated using Prostate Cancer Working Group Criteria 3 (PCWG 3). Survival was assessed using Kaplan-Meier estimates and Cox proportional hazards regression analysis. This retrospective study was approved by the local ethics committee.

RESULTS:

A total of 139 treatment cycles with Lu-177-PSMA-617 were performed. A decline of 50% or more of prostate-specific antigen (PSA) level occurred in 54% and a PSA decline of any amount in 65% of patients. The estimated median overall survival (OS) was 16 months, in the chemotherapy subgroup 14 months. A longer OS was associated with a PSA-decline ≥50%, more than 2 cycles of therapy, cumulative activity >15 GBq and an initial alkaline phosphatase ≤ 220 [U/l]. These identified predictors remained significant on uni- and multivariate Cox regression analysis. Moreover, 40% of the patients who were non-responders after the first therapy cycle turned into responders after the second one.

CONCLUSION:

PSA-decline ≥50%, a cumulative activity >15 GBq and an initial alkaline phosphatase ≤ 220 [U/l] were identified as key predictors of prolonged OS in patients with mCRPC. In contrast rapid clinical deterioration mostly due to skeletal carcinomatosis resulted in early treatment failure.

• Authors: Charlotte A Schneider, Philipp Täger, Jochen Hammes, Thomas Fischer, Alexander Drzezga, David Pfister, Axel Heidenreich, Matthias Schmidt
• Journal: Nuklearmedizin. Nuclear medicine (Nuklearmedizin) Vol. 61 Issue 1 Pg. 25-32 (Feb 2022) ISSN: 2567-6407 [Electronic] Germany
• Vernacular Title: Behandlungsergebnisse und Einflussfaktoren auf das Gesamtüberleben nach Lu-177-PSMA-617 Radioligandentherapie des metastasierten Prostatakarzinoms.
• PMID: 34918333 (Publication Type: Journal Article)
• Copyright: Thieme. All rights reserved.

Chemical References

• Dipeptides
• Heterocyclic Compounds, 1-Ring
• PSMA-617
• Radioisotopes
• Lutetium
• Lutetium-177
• Prostate-Specific Antigen

Topics

• Aged
• Aged, 80 and over
• Dipeptides (therapeutic use)
• Heterocyclic Compounds, 1-Ring (therapeutic use)
• Humans
• Lutetium
• Male
• Middle Aged
• Prostate-Specific Antigen
• Prostatic Neoplasms, Castration-Resistant (radiotherapy)
• Radioisotopes (therapeutic use)
• Retrospective Studies
• Treatment Outcome