Clinical outcomes of 177lutetium-prostate-specific membrane antigen therapy in advanced prostate cancer—a prospective pilot study in an Asian population. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Thang, Sue Ping; Lam, Winnie Wing Chuen; Tong, Aaron Kian Ti; Allen, John Carson; Ler, Anna Siah Lee; Tay, Young Soon; Somanesan, Soma; Kanesvaran, Ravindran; Wong, Alvin Seng Cheong; Ng, David Chee Eng
• Is Part Of: Nuclear medicine communications. Volume 41:Issue 7(2020)
• Publication Date: 2020-07
• Subjects: lutetium -- prostate -- prostate-specific membrane antigen -- radionuclide therapy; Nuclear medicine -- Periodicals; 616.07575
• DOI: 10.1097/MNM.0000000000001179
• Languages: English
• ISSNs: 0143-3636

Abstract

Abstract : Objective: Metastatic castration-resistant prostate cancers are aggressive tumors with poor prognosis. Prostate-specific membrane antigen-targeted radionuclide therapy is a potential treatment for these patients. Here, we report our initial experience in Singapore. Methods: Twenty men (median age 70) with progressive disease were prospectively recruited. Prostate-specific membrane antigen and fluorodeoxyglucose-PET/computed tomography were performed to confirm high prostate-specific membrane antigen-expression. Up to four cycles of 177 lutetium-prostate-specific membrane antigen-I&T at 6–8 weekly intervals were administered. Patients were restaged 3 months following treatment. Primary endpoints were prostate-specific antigen decline ≥50% and treatment-related toxicity. Additional endpoints included radiological and clinical response as well as progression-free survival and overall survival from first cycle. Results: Sixty-seven cycles were administered (median 4 cycles per patient, mean 6.5 GBq per cycle). Sixty five percent had ≥1 line of prior chemotherapy, 90% abiraterone, enzalutamide or both, and 30% radium-223 radionuclide therapy. All had bone metastases and 35% had visceral metastases. Prostate-specific antigen decline ≥50% was achieved in 50%. Grade 3–4 hematotoxicity was seen in up to 15%. Grade 3–4 non-hematotoxicity was not observed. Eleven patients had restaging scans 3 months post-treatment (5 = partial response, 6 = progressive disease). Fifty-seven percent (4/7) with bone pain had pain improvement. Median progression-free survival was 5.9 months and median overall survival 13.1 months. Patients with prostate-specific antigen decline ≥50% had longer progression-free survival and overall survival. Conclusion: 177 Lutetium-prostate-specific membrane antigen-I&T therapy is effective with tolerable side effects in our local setting. Prostate-specific antigen decline ≥50% is associated with longer progression-free survival and overall survival.