gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

PSMA PET/MRI and Lu177 PSMA therapy in relapsing malignant glioma

PSMA PET/MRT und Lu177 PSMA-Therapie in Patienten mit rezidivierendem malignem Gliom

Meeting Abstract

  • presenting/speaker Peter Truckenmüller - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Josefine Graef - Charité – Universitätsmedizin Berlin, Klinik für Nuklearmedizin, Berlin, Deutschland
  • Christian Furth - Charité – Universitätsmedizin Berlin, Klinik für Nuklearmedizin, Berlin, Deutschland
  • Holger Amthauer - Charité – Universitätsmedizin Berlin, Klinik für Nuklearmedizin, Berlin, Deutschland
  • Winfried Brenner - Charité – Universitätsmedizin Berlin, Klinik für Nuklearmedizin, Berlin, Deutschland; Deutsches Konsortium für Translationale Krebsforschung, Deutsches Krebsforschungszentrum, Berlin, Deutschland
  • David Capper - Charité – Universitätsmedizin Berlin, Institut für Neuropathologie, Berlin, Deutschland; Deutsches Konsortium für Translationale Krebsforschung, Deutsches Krebsforschungszentrum, Berlin, Deutschland; Berlin Institute of Health (BIH), Berlin, Deutschland
  • Julia Sophie Onken - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland; Deutsches Konsortium für Translationale Krebsforschung, Deutsches Krebsforschungszentrum, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV319

doi: 10.3205/22dgnc306, urn:nbn:de:0183-22dgnc3064

Published: May 25, 2022

© 2022 Truckenmüller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Malignant gliomas (MG) are still associated with an unacceptable poor prognosis. New therapeutic targets and strategies are needed to improve patients' survival while preserving health related quality of life. To date, prostate specific membrane antigen (PSMA) is discussed as a therapeutic target for PSMA-directed radioligand therapy (Lu177-PSMA therapy). With this study we aim to investigate and correlate PSMA expression to PSMA tracer uptake in relapsing MG. Further, we provide data of our first experiences with Lu177-PSMA therapy in three patients with relapsing MG.

Methods: Patients with relapsing MG and no other available treatment options have been subjected to PSMA PET/MRI diagnostics to evaluate eligibility for Lu177-PSMA therapy. Quantitative imaging data has been correlated with histopathologically determined PSMA expression. Common toxicity criteria (CTC-AE v5.0) and nuclear medicine data have been assessed in patients who received Lu177-PSMA therapy.

Results: In total 20 patients with a median age of 53 (IQR 42-57) years and a female-to-male ratio of 1:3 were evaluated with PSMA PET/MRI. Median SUVmean was 3.2 (IQR 2.5-3.9) in the tumor and 4.3 (IQR 3.6-5.7) in the liver. Tumor-to-liver ratio of SUVmean was 0.7 (IQR 0.6-0.9). In three patients, we observed a significant uptake with consecutive tumor-to-liver ratios of 1.2, 1.4 and 1.5 and therefore, those patients have been subjected to Lu177-PSMA therapy. So far, each patient has completed two cycles of therapy. In one patient, CTC AE °2 with a thrombocytopenia of 68 / nl related to the treatment occurred. Histological studies exhibited variable PSMA expression but suggested a correlation of high PSMA expression in the tumor neovasculatur in patients with increased PSMA uptake of the tumor.

Conclusion: With this study, we show that only few (15%) patients with relapsing MG qualified for Lu177-PSMA therapy. However, our preliminary data demonstrated acceptable toxicity. Further, PSMA expression in the neovasculature of MG may correspond with the PSMA uptake. More patients need to be evaluated to prove PSMA staining as a screening tool prior to PSMA PET initiation, and to draw conclusions on toxicity and efficacy of Lu177 PSMA therapy.