Recent article about Lutetium 177 treatment in advanced mCRPC by doctors at the Technical University of Munich

Authors:

Matthias Michael Heck, Sebastian Schwaiger, Karina Knorr, Margitta Retz, Tobias Maurer, Friederike Janssen, Calogero D´Alessandria, Hans-Juergen Wester, Juergen E. Gschwend, Markus Schwaiger, Robert Tauber, Matthias Eiber; Rechts der Isar University Hospital, Technical University of Munich, Munich, Germany; Technical University of Munich, Munich, Germany

Abstract Disclosures

Background:

To report our clinical experience with 177Lutetium-labeled prostate-specific membrane antigen-ligand (177Lu-PSMA-I&T) for systemic radioligand therapy in 100 consecutive patients with metastatic castration-resistant prostate cancer (mCRPC).

Methods:

All patients were treated under a review board-approved compassionate use protocol. Eligibility criteria for 177Lu-PSMA-I&T therapy included previous treatment with abiraterone or enzalutamide, previous taxane-based chemotherapy or unsuitability for taxanes as well as positive 68Ga-PSMA tracer uptake of metastases in a prior PET-scan. Intravenous treatment with 177Lu-PSMA-I&T was given 6- to 8-weekly with an activity of 7.4GBq up to 6 cycles in patients without clinical or radiographic progression. We report prostate-specific antigen (PSA) decline, PSA progression-free survival (PSA-PFS), clinical progression-free survival (cPFS) and overall survival (OS) as well as toxicity.

Results:

Median age was 72 years (range 46-85) and median PSA level was 164 ng/ml (range 0-6178). Bone, lymph node and visceral metastases were present in 94%, 85% and 33% of patients, respectively. The median number of previous treatment regimens for mCRPC was 3 (range 1-6) and 84% of patients were pretreated with chemotherapy. At the time of evaluation, 286 cycles with 177Lu-PSMA-I&T were applied (median 2 cycles per patient, range 1-6), while treatment was still ongoing in 27% of patients. Overall, 4 and 6 cycles were applied in 33 and 15 patients, respectively. PSA decline ≥30%, ≥50% and ≥90% was achieved in 40%, 32% and 9% of patients, respectively. Median PSA-PFS was 3.4 months (95%CI 2.7-4.0), median cPFS was 4.1 months (95%CI 2.5-5.7) and median OS was 12.2 months (95%CI 8.8-15.7). Treatment-emergent hematologic grade 3/4 toxicities were anemia in 7%, thrombocytopenia in 5% and neutropenia in 4% of patients. Grade 3/4-non-hematologic toxicities were not observed. The main non-hematologic grade 1/2 toxicities were dry mouth in 18%, fatigue in 16% and loss of appetite in 9/% of patients.

Conclusions:

Radioligand therapy with 177Lu-PSMA I&T appears to be safe and active in late-stage mCRPC.

[MelaniePaul]

As I always say, this is a very interesting therapy. But it doesn't seem to be effective in poorely differentiated tumors. They should include that in their papers...

[Daddysdaughter]

Hidden, can you tell us your experience with Lu-177? How long has the one treatment lasted?