Nucl Med Mol Imaging.  2019 Dec;53(6):423-431. 10.1007/s13139-019-00624-8.

Safety Profile and Therapeutic Efficacy of One Cycle of Lu177-PSMA in End-Stage Metastatic Castration-Resistant Prostate Cancer Patients with Low Performance Status

• Gupta M
• Choudhury
• Rawal S
• Karthikeyan G
• Talwar V
• Dutta KD
• Singh A

• KMID: 2469586
• DOI: http://doi.org/10.1007/s13139-019-00624-8

Abstract

PURPOSE
The aim of this study was to evaluate safety and therapeutic efficacy of lutetium 177 prostate-specific membrane antigen (Lu-177-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) patients with low performance status.
METHODS
Twenty-two patients already treated with anti-androgens and docetaxel were enrolled for one cycle of Lu-177-PSMA therapy. Haemoglobin, total leukocyte counts, platelets and serum creatinine for toxicity profile while prostate specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) performance status, visual analogue scale (VAS) and analgesic quantification scale (AQS) for therapeutic efficacy were recorded pre and 8 weeks post therapy. Wilcoxon signed-rank and ANOVA tests were used for statistical analysis.
RESULTS
Partial response (PR), stable disease (SD) and progressive disease (PD) for PSAwere seen in 5 (22.7%), 13 (59.1%) and 4 (18.2%) patients respectively treated with mean 6.88 GBq dose of Lu-177-PSMA. 8/22 (36.4%) patients showed ≥ 30% drop in PSA. Grade 3 haemoglobin toxicity was seen in 5/22 (22.7%) patients. No patient developed grade 4 haemoglobin toxicity. No patients had grade 3 or 4 leukocytopenia or thrombocytopenia. Wilcoxon signed-rank test showed statistical significant (P < 0.05) difference in pre and post treatment ECOG, VAS, and AQS scores. The ANOVA test showed statistically significant difference in mean doses of Lu-177-PSMA used in three PSA response groups while difference was non-significant for other variables.
CONCLUSION
We concluded that Lu-177-PSMA therapy has adequate pain palliation in end-stage mCRPC patients with low performance status and it has a potential to become effective therapeutic option in properly selected patients.

Keyword

Lu-177-PSMA; Safety and efficacy; Metastatic castration resistant prostate cancer; Low performance status

MeSH Terms

Creatinine
Humans
Leukocyte Count
Leukopenia
Lutetium
Membranes
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms*
Thrombocytopenia
Creatinine
Lutetium
Prostate-Specific Antigen