Repeated 177Lu-labeled PSMA-617 radioligand therapy using treatment activities of up to 9.3 GBq

• Verfasst von: Rathke, Hendrik [VerfasserIn]
• Verfasst von: Giesel, Frederik L. [VerfasserIn]
• Verfasst von: Flechsig, Paul [VerfasserIn]
• Verfasst von: Mier, Walter [VerfasserIn]
• Verfasst von: Hohenfellner, Markus [VerfasserIn]
• Verfasst von: Haberkorn, Uwe [VerfasserIn]
• Verfasst von: Kratochwil, Clemens [VerfasserIn]
• Titel: Repeated 177Lu-labeled PSMA-617 radioligand therapy using treatment activities of up to 9.3 GBq
• Verf.angabe: Hendrik Rathke, Frederik L. Giesel, Paul Flechsig, Klaus Kopka, Walter Mier, Markus Hohenfellner, Uwe Haberkorn, and Clemens Kratochwil
• Jahr: 2018
• Jahr des Originals: 2017
• Umfang: 7 S.
• Fussnoten: Published online Aug. 10, 2017 ; Im Titel ist "177" in 177Lu-labeled hochgestellt ; Gesehen am 09.04.2018
• Titel Quelle: Enthalten in: Journal of nuclear medicine
• Ort Quelle: New York, NY : Soc., 1964
• Jahr Quelle: 2018
• Band/Heft Quelle: 59(2018), 3, Seite 459-465
• ISSN Quelle: 2159-662X
• ISSN Quelle: 1535-5667
• DOI: doi:10.2967/jnumed.117.194209
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: 177Lu
• Sach-SW: 177Lu-PSMA-617
• Sach-SW: metastasized castration-resistant prostate cancer
• Sach-SW: PSMA-RLT
• K10plus-PPN: 1571841210

Abstract

Current treatment protocols for 177Lu-labeled PSMA-617 therapies were cautiously derived from dosimetry data, but their practical appropriateness has not yet been proven clinically. We retrospectively report our clinical observations using 4 different treatment activities. Methods: Forty patients with advanced prostate cancer and positive uptake in prostate-specific membrane antigen (PSMA) imaging were treated with 4 GBq of 177Lu activity/80 nmol of precursor, 6 GBq of 177Lu activity/120 nmol of precursor, 7.4 GBq of 177Lu activity/150 nmol of precursor, or 9.3 GBq of 177Lu activity/150 nmol of precursor (10 patients per group) every 2 mo. Safety was checked every 2 wk by laboratory tests, the prostate-specific antigen response was checked every 4 wk, and other effects were assessed by anamnesis. Results: The initial prostate-specific antigen response showed no correlation with treatment activity. However, 2 of 10, 4 of 10, 4 of 10, and 7 of 10 patients receiving doses of 4, 6, 7.4, and 9.3 GBq, respectively, were in partial remission 8 wk after completing all 3 cycles. This finding would be in line with but—because of low patient numbers—would not prove a positive dose-response relationship. Acute hematologic toxicity was also not correlated with treatment activity, and no more than 1 patient per group had grade 3/4 toxicity. Nevertheless, in contrast to the findings for the other groups, the mean platelet count in the 9.3-GBq group decreased chronically over time. Conclusion: If patients with diffuse red marrow infiltration and extensive chemotherapeutic pretreatments are excluded, then treatment activities of up to 3 injections of 9.3 GBq of 177Lu-PSMA-617 every 2 mo are tolerated well. Further dose escalation should be conducted with care, as the highest dose seems to be close to the maximum tolerable dose.