Artikel
Systemic radioligand therapy with Lutetium-177 PSMA I&T in patients with metastatic castration-resistant prostate cancer
Suche in Medline nach
Autoren
Veröffentlicht: | 20. April 2016 |
---|
Gliederung
Text
Background: Prostate-specific membrane antigen (PSMA) is a potential therapeutic target in metastatic castration-resistant prostate cancer (mCRPC). We report our initial clinical experience with a beta-emitting 177Lutetium-labeled PSMA-ligand (177Lu-PSMA I&T) for systemic radioligand therapy in mCRPC patients.
Patients and methods: 22 mCRPC patients who experienced treatment failure with both chemotherapy and novel androgen-receptor targeted therapy were treated 8-weekly with up to 4 cycles of 177Lu-PSMA I&T. All patients were reevaluated with a 68Ga-PSMA PET/CT-scan after each cycle. We report safety data, antitumor response with prostate specific antigen (PSA) declines and radiografic tumor response as well as clinical outcome with changes in Eastern Cooperative Oncology Group (ECOG) performance status and pain severity.
Results: The first 3 patients were treated with a lower activity of 3.7 GBq in their first cycle. Due to a favourable safety profile the activity was increased to 7.4 GBq in 19 subsequent patients who completed a total of 40 cycles. With the higher activity no grade 3/4 toxicities were observed. The main non-hematologic and hematologic grade 1/2 toxicities were dry mouth in 7 (37%), anemia in 6 (32%) and thrombopenia in 5 (25%) patients.
The proportion of patients achieving a maximum PSA decline of ≥ 30%, ≥ 50% and ≥ 90% was 56%; 28% and 11%, respectively. Combined assessment of bone and soft tissue metastases showed a complete remission in 5%, stable disease in 63% and progressive disease in 32% of patients.
ECOG performance status improved or was stable in 74% of patients. Of men with bone pain; 58% achieved complete resolution or reduced pain.
Conclusion: Radioligand therapy with 177Lu-PSMA I&T appears to be safe and active in heavily pretreated mCRPC patients. Further prospective evaluation in larger patient cohorts is encouraged.