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68Ga-PSMA-11 PET/CT Follow-Up of Patients with Prostate Cancer with Bone Metastases Who Had Reduced Bone Density after Androgen Deprivation Therapy
Brief Report

Efficacy and Haematologic Toxicity of Palliative Radioligand Therapy of Metastatic Castrate-Resistant Prostate Cancer with Lutetium-177-Labeled Prostate-Specific Membrane Antigen in Heavily Pre-Treated Patients

1
Department of Haematology, School of Medicine, The University of Western Australia, Perth 6009, Australia
2
Department of Nuclear Medicine, School of Medicine, The University of Western Australia, Perth 6009, Australia
3
GenesisCare, East Fremantle, Fremantle 6158, Australia
4
School of Medicine, The University of Notre Dame, Fremantle 6160, Australia
*
Author to whom correspondence should be addressed.
Academic Editors: Jochen Neuhaus and Finn Edler von Eyben
Diagnostics 2021, 11(3), 515; https://doi.org/10.3390/diagnostics11030515
Received: 2 March 2021 / Revised: 11 March 2021 / Accepted: 12 March 2021 / Published: 14 March 2021
(This article belongs to the Special Issue PSMA in Prostate Cancer)
Background: Metastatic castration-resistant prostate cancer (mCRPC) remains a significant contributor to the global cancer burden. lutetium-177-prostate-specific membrane antigen radioligand therapy (177Lu-PSMA RLT) is an effective salvage treatment. However, studies have highlighted haematologic toxicity as an adverse event of concern. We report our single-centre experience of compassionate access palliative 177Lu-DOTAGA-(I-y)fk(Sub-KuE) (177Lu-PSMA I&T) with respect to efficacy and haematologic safety. Methods: Patients with mCRPC and adequate bone marrow/liver function were included. All patients included underwent baseline and response assessment by Gallium-68-PSMA-11 positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT). Prescribed activity of therapy was a median 6.24 GBq per patient per cycle (IQR1.29 GBq), administered in 8-week intervals, up to four cycles. Response was assessed by prostate specific antigen (PSA) and a week-12 PET/CT. Incidence of grade ≥ 3 haematologic toxicity, including association with risk factors (age ≥ 70 years, prior/concurrent therapy, presence of metastases, and number of cycles completed), was analysed. Results: One hundred patients completed one cycle of 177Lu PSMA I&T and underwent response assessment by both PSA and PET/CT. Two patients had an uninterpretable week-12 PET/CT. Median age was 70 (50–89), median number of prior therapies was three (1–6), and median follow up was 12-months. Fifty-four percent achieved a PSA response. Disease control rate (DCR) by PET/CT was 64% (29% SD, 34% PR, and 1% CR). Disease control by PET/CT was associated with an improved one-year overall survival (OS) compared to non-responders, median OS not-reached vs 10-months (p < 0.0001; 95% CI: 0.08–0.44). Regarding haematologic toxicity, 11% experienced a grade ≥ 3 cytopenia (self-limiting). No cases of myelodysplasia/acute leukaemia (MDS/AL) have been recorded. No association with risk factors was demonstrated. Conclusion: 177Lu-PSMA I&T is a safe and effective palliative outpatient treatment for mCRPC. 68Ga-PSMA-11 PET/CT response is associated with an improved one-year OS and may be used to adapt therapy. View Full-Text
Keywords: LuPSMA; mCRPC; hematologic toxicity; MDS LuPSMA; mCRPC; hematologic toxicity; MDS
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MDPI and ACS Style

Kesavan, M.; Meyrick, D.; Gallyamov, M.; Turner, J.H.; Yeo, S.; Cardaci, G.; Lenzo, N.P. Efficacy and Haematologic Toxicity of Palliative Radioligand Therapy of Metastatic Castrate-Resistant Prostate Cancer with Lutetium-177-Labeled Prostate-Specific Membrane Antigen in Heavily Pre-Treated Patients. Diagnostics 2021, 11, 515. https://doi.org/10.3390/diagnostics11030515

AMA Style

Kesavan M, Meyrick D, Gallyamov M, Turner JH, Yeo S, Cardaci G, Lenzo NP. Efficacy and Haematologic Toxicity of Palliative Radioligand Therapy of Metastatic Castrate-Resistant Prostate Cancer with Lutetium-177-Labeled Prostate-Specific Membrane Antigen in Heavily Pre-Treated Patients. Diagnostics. 2021; 11(3):515. https://doi.org/10.3390/diagnostics11030515

Chicago/Turabian Style

Kesavan, Murali, Danielle Meyrick, Marat Gallyamov, J. H. Turner, Sharon Yeo, Giuseppe Cardaci, and Nat P. Lenzo. 2021. "Efficacy and Haematologic Toxicity of Palliative Radioligand Therapy of Metastatic Castrate-Resistant Prostate Cancer with Lutetium-177-Labeled Prostate-Specific Membrane Antigen in Heavily Pre-Treated Patients" Diagnostics 11, no. 3: 515. https://doi.org/10.3390/diagnostics11030515

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