177Lu-PSMA-617 RLT en mCRPC: experiencia de un solo centro, cuanto antes podría ser mejor / 177Lu-PSMA-617 RLT in mCRPC: A single center experience, the earlier could be the better

Introducción La terapia con radioligando que se dirige al antígeno de membrana específico de la próstata (PSMA) se ha considerado recientemente como una opción en el tratamiento del cáncer de próstata resistente a la castración metastásica (mCRPC). El objetivo de este estudio fue evaluar los datos bioquímicos, cliónicos y radiológicos de los pacientes que recibieron tratamiento con 177-Lu-PSMA-617 RLT en nuestra cliónica tras el diagnóstico de mCRPC, e investigar la relación entre el momento del tratamiento y la localización de las metástasis y la supervivencia. Material y métodos Este es un estudio observacional retrospectivo realizado en un único centro de diciembre de 2016 a diciembre de 2019. Los pacientes se sometieron a tratamiento con 177-Lu-PSMA-617 RLT con un diagnóstico de mCRPC. Usamos la prueba de Kaplan-Meier y la prueba de riesgo proporcional de regresión de Cox para evaluar los datos de supervivencia. Resultados Se incluyeron 95 pacientes con una edad promedio de 70,45 años (50-85). La mediana de seguimiento fue de 10,86 meses (8,15-11,94) y la mediana de las líneas de tratamiento con 177-Lu-PSMA-617 RLT fue de 4 (1-5). Se encontró que la mediana de supervivencia global fue de 17,03±5,78 meses en los pacientes que recibieron el tratamiento en la tercera línea o líneas inferiores, mientras que fue de 10,30±0,93 meses en los pacientes que recibieron el tratamiento en la cuarta línea o más (p±0,021). Al evaluar a los pacientes con metástasis únicamente óseas y a los pacientes con metástasis óseas y ganglionares, la mediana de supervivencia global fue de 11,46±0,87 meses y 12,13±3,02 meses (p=0,445), respectivamente. Conclusión El tratamiento con 177-Lu-PSMA-617 RLT proporciona una mejor supervivencia en el tratamiento de pacientes diagnosticados con mCRPC después de tratamientos estándar que lo recibieron anteriormente (AU)

Introduction Radioligand therapy which targets the prostate specific membrane antigen (PSMA) has recently considered as option in the treatment of metastatic castration resistant prostate cancer (mCRPC). The aim of this study was to evaluate the biochemical, clinical and radiological data of patients received treatment with 177-Lu-PSMA-617 RLT in our clinic following the diagnosis of mCRPC, and to investigate the relationship between treatment timing and metastasis region and survival. Material and method This is a retrospective, observational, single-center study from December 2016 to December 2019. Patients underwent 177-Lu-PSMA-617 RLT with a diagnosis of mCRPC. We used the Kaplan-Meier test and the Cox regression proportional hazard test to assess survival data. Results 95 patients with an average age of 70.45 (50-85) were evaluated retrospectively. Median follow-up was 10.86 months (8.15-11.94 months) and the median lines of 177-Lu-PSMA-617 RLT treatment was 4 (1 to 5). Median overall survival was found to be 17.03±5.78 months in the patients receiving the treatment at the third or lower lines while it was 10.30±0.93 months in patients receiving the treatment at the fourth or higher lines (p=0.021). When evaluating patients with only bone metastasis and patients with bone and lymph node metastasis, the median overall survival was 11.46±0.87 months and 12.13±3.02 months (p=0.445), respectively. Conclusion 177-Lu-PSMA-617 RLT treatment provides better survival in the treatment of patients diagnosed with mCRPC after standard treatments and received it earlier. 177-Lu-PSMA-617 RLT treatment could be an effective treatment method in mCRPC patients with bone and lymph node metastasis (AU)

An automated synthesis of 177Lu-EDTMP as an efficient bone-seeking therapeutic radiopharmaceutical.

OBJECTIVE: Radiolabeled bisphosphonates have found wide clinical use in nuclear medicine for palliative therapy of bone metastases. 177Lu-EDTMP was used to relieve metastatic bone pain in patients with breast or prostate cancer. The therapeutic efficacy of 177Lu-EDTMP at 1-, 3-, 6-, and 8-weeks post-therapy was evaluated using Standard Pain Scoring Assessment Criteria. In addition, toxicity was evaluated in terms of hematological parameters using the Common Terminology Criteria for Adverse Events V4.0. PATIENTS AND METHODS: A fully automated synthesis of 177Lu-EDTMP was achieved in this study with high radiochemical efficiency and high radiochemical purity. During the study, 75 patients (57 M: 18 F, mean age: 68.0 ± 11.1 years) of breast/prostate cancer with documented skeletal metastases were included. Patients were administered intravenously with 177Lu-EDTMP at a dose rate of 22.2-37.0 MBq/kg following a fully automated synthesis of 177Lu-EDTMP using a disposable cassette system. RESULTS: Among the 75 patients all treated with 177Lu-EDTMP, 59 patients were responsive and the remaining 16 patients did not respond to the therapy. Mean pain score values in the responder group were 5.60 ± 0.5, 4.3 ± 0.1, 2.6 ± 0.4 and 1.4 ± 0.7 at weeks 1, 3, 6, and 8, respectively. Also, the mean pain score decreased from a baseline score of 7.6 ± 1.6 to 1.4 ± 0.7 at week 8 in the responder group. Statistical analysis of the pain score data showed a significant decrease in pain score after each radiopharmaceutical treatment, compared to the baseline scores (p <0.0001). Mild to severe toxicity was observed in two patients each treated with 177Lu-EDTMP. CONCLUSIONS: These findings demonstrated that the 177Lu-EDTMP radiopharmaceutical could be used safely to achieve considerable therapeutic efficacy, in metastatic bone pain palliation together with the safe clinical application and low radiation exposure during preparation.