Ferdinandus Justin, Eppard Elisabeth, Gaertner Florian C, Kürpig Stefan, Fimmers Rolf, Yordanova Anna, Hauser Stefan, Feldmann Georg, Essler Markus, Ahmadzadehfar Hojjat
Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany.
Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
J Nucl Med. 2017 Feb;58(2):312-319. doi: 10.2967/jnumed.116.178228. Epub 2016 Sep 1.
Radioligand therapy (RLT) with Lu-PSMA-617 (PSMA is prostate-specific membrane antigen) is a novel targeted therapy for metastatic prostate cancer. In this study, we evaluated the effect of different pretherapeutic parameters on the therapeutic response measured by prostate-specific antigen (PSA) 2 mo after RLT.
RLT was performed in 40 hormone-refractory patients with distant metastases and progressive disease (mean age, 71.4 y). Ga-PSMA-11 PET/CT was performed in all patients 1-2 wk before RLT. All patients were treated with a mean of 6 GBq. The SUV of tumor lesions was determined using region-of-interest analysis. Complete blood counts, renal and liver function assessments, previous therapies, pain medication, and SUVs were included in the analysis. PSA was assessed 2 mo after RLT.
In the univariate analysis, younger age, higher levels of γ-glutamyl transferase, lower pretherapeutic hemoglobin, a higher Gleason score, a higher number of platelets, higher C-reactive protein, regular need for pain medication, and higher lactate dehydrogenase had a negative impact on the therapeutic response; however, the multivariate analysis revealed that the most significant independent factors were the number of platelets and regular need for pain medication. The response was independent of the amount of PSMA uptake as well as previous therapies and other measured factors.
A PSA decline of more than 50% was observed significantly more in patients without a regular need for analgesics.
使用镥-前列腺特异性膜抗原-617（PSMA是前列腺特异性膜抗原）进行放射性配体疗法（RLT）是转移性前列腺癌的一种新型靶向疗法。在本研究中，我们评估了不同治疗前参数对放射性配体疗法后2个月通过前列腺特异性抗原（PSA）测量的治疗反应的影响。
对40例激素难治性远处转移和疾病进展患者（平均年龄71.4岁）进行放射性配体疗法。在放射性配体疗法前1-2周对所有患者进行镓-前列腺特异性膜抗原-11正电子发射断层扫描/计算机断层扫描（Ga-PSMA-11 PET/CT）。所有患者平均接受6吉贝可的治疗。使用感兴趣区域分析确定肿瘤病变的标准化摄取值（SUV）。分析包括全血细胞计数、肾功能和肝功能评估、既往治疗、止痛药物以及SUV。在放射性配体疗法后2个月评估PSA。
单因素分析中，年龄较小、γ-谷氨酰转移酶水平较高、治疗前血红蛋白较低、Gleason评分较高、血小板数量较多、C反应蛋白较高、经常需要止痛药物以及乳酸脱氢酶较高对治疗反应有负面影响；然而，多因素分析显示，最显著的独立因素是血小板数量和经常需要止痛药物。反应与PSMA摄取量以及既往治疗和其他测量因素无关。
在不需要经常使用镇痛药的患者中，观察到PSA下降超过50%的情况明显更多。
