von Eyben Finn Edler, Singh Aviral, Zhang Jingjing, Nipsch Karin, Meyrick Danielle, Lenzo Nat, Kairemo Kalevi, Joensuu Timo, Virgolini Irene, Soydal Cigdem, Kulkarni Harshad R, Baum Richard Paul
Center of Tobacco Control Research, Odense, Denmark.
Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, Bad Berka, Germany.
Oncotarget. 2019 Mar 29;10(25):2451-2461. doi: 10.18632/oncotarget.26789.
Lu-PSMA radioligand therapy (LuPRLT) is mainly used for patients with metastatic castration-resistant prostate cancer who are resistant to established drugs. This study describes LuPRLT, either LuPSMA I&T or LuPSMA RLT-617, for 45 patients with predominant lymph node metastatic prostate cancer (LNM PC). Thirty-five patients had LNM and ten patients had LNM and one or two bone metastases. Before LuPRLT, the patients had prostate specific antigen (PSA) of median 18 µg/l (interquartile range (IQR): 3.3-39). LuPRLT was given with a cumulative injected Lu activity of median 14.5 GBq (IQR: 12.2-20.4). Maximum percentage decline of PSA was median 92% (IQR: 70-99). Thirty-five patients with only LNM had a better overall survival (OS) than ten patients with LNM and one or two bone metastases. Thirty-three docetaxel-naïve patients had a longer PSMA PET/CT progression-free survival than twelve patients who were resistant to docetaxel. Twenty-two patients who received LuPRLT with a cumulative injected Lu activity ≥ 14.8 GBq had a better PSMA PET/CT progression-free survival than 23 patients who received LuPRLT with a lower cumulative injected Lu activity. Seventeen patients with relapse after LuPRLT who received rechallenge LuPRLT or ActPRLT had a better OS than five patients who received other forms for relapse treatment. LuPRLT gave mild and transitory adverse effects. The findings of the present study suggest that LuPRLT of patients with LNM may be effective and safe. The promising results motivate randomized phase II trials to further quantify the impact of LuPRLT as treatment of patients with LNM.
镥-前列腺特异性膜抗原放射性配体疗法（LuPRLT）主要用于对现有药物耐药的转移性去势抵抗性前列腺癌患者。本研究描述了针对45例以淋巴结转移为主的前列腺癌（LNM PC）患者使用LuPRLT，即镥-前列腺特异性膜抗原成像与治疗（LuPSMA I&T）或镥-前列腺特异性膜抗原放射性配体疗法-617（LuPSMA RLT-617）。35例患者有淋巴结转移，10例患者有淋巴结转移且有一或两处骨转移。在进行LuPRLT之前，患者的前列腺特异性抗原（PSA）中位数为18 μg/l（四分位间距（IQR）：3.3 - 39）。给予LuPRLT时，累积注入的镥活度中位数为14.5 GBq（IQR：12.2 - 20.4）。PSA的最大下降百分比中位数为92%（IQR：70 - 99）。35例仅有淋巴结转移的患者的总生存期（OS）优于10例有淋巴结转移且有一或两处骨转移的患者。33例未接受过多西他赛治疗的患者的前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（PSMA PET/CT）无进展生存期长于12例对多西他赛耐药的患者。22例接受累积注入镥活度≥14.8 GBq的LuPRLT的患者的PSMA PET/CT无进展生存期优于23例接受较低累积注入镥活度的LuPRLT的患者。17例LuPRLT后复发且接受再次挑战LuPRLT或醋酸阿比特龙放射性配体疗法（ActPRLT）的患者的OS优于5例接受其他形式复发治疗的患者。LuPRLT产生轻度且短暂的不良反应。本研究结果表明，LNM患者的LuPRLT可能有效且安全。这些有前景的结果促使开展随机II期试验，以进一步量化LuPRLT作为LNM患者治疗方法的影响。
