177Lutetium-prostate-specific membrane antigen radionuclide therapy of patients with metastatic castration-resistant prostate cancer
Finn Edler von Eybena, Harshad R. Kulkarnib, Karin Nipsch b, Richard P. Baum b
a Center of Tobacco Control Research, Odense, Denmark, bTheranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany,
Purpose. The aim of the study was to compared overall survival (OS) after treatment with 177Lutetium [177Lu]-prostate specific membrane antigen (PSMA) radioligand therapy (LuPRLT) of four groups of patients with metastatic castration-resistant prostate cancer (mCRPC). We evaluated those with LNM, bone metastases, lung metastases, and liver metastases.
Patients and Methods. The patients participated in a prospective study. The patients had had extensive previous treatments, often including abiraterone and docetaxel. At the time of LuPRLT, 22 patients had LNM, 102 had bone metastases, 21 had lung metastases, and 23 had liver metastases. Initially LuPRLT was given as LuPSMA I&T, and later as LuPSMA-617. LuPRLT was given in cycles with median 6 GBq per cycle at 8 weeks intervals.
Results.The patients were given baseline LuPRLT series with median 3 cycles. The four groups differed in OS (P < 0.0001, log-rank test), as shown in Figure. Patients with LNM had a 75% OS after 46 months of follow-up. Patients with bone and lung metastases had grossly similar OS (median 15 and 21 months), Patients with liver metastases had the worst OS (median 10 months). LuPRLT gave mild and transitory adverse effects.
Conclusion. After treatment with LuPRLT, patients with LNM had a much better OS than patients with more advanced mCRPC. Patients with bone and lung metastases had grossly similar survival. The OS for patients with LNM is promising but needs to be validated in randomized trials.
The Figure shows OS for patients with LNM (site 1), bone metastases (site 3), lung metastases (site 4), and liver metastases (site 5).
